HAART Era Research Articles

A comparison of clinical profile and treatment outcome of Hodgkin’s Lymphoma in Tanzania according to HIV status during the HAART era

BackgroundThe incidence of Hodgkin's lymphoma (HL) in people living with HIV (PLWHA) and on HAART is approximately 20–30 times higher than in HIV-negative individuals. Most patients with HIV-HL present at an advanced stage (III-IV) have 'B' symptoms and extranodal involvement. The natural history and risk stratification of HIV-HL has undergone a significant change as a result of HAART's rollout. This study investigated the differences in clinicopathological and survival patterns of HL among individuals with and without HIV disease in Tanzania during the HAART era.MethodologyThis hospital-based retrospective cohort study was conducted at the ORCI, Dar-Es-Salaam, Tanzania. Chi-square and Fisher’s exact tests were used to compare proportions. The student t-test was used to compare means. To determine factors that predict survival, we used the log-rank test to analyze the variables in univariate analysis. A Cox regression model was used to analyze the significant factors from univariate analysis in multivariate analysis.ResultsEighty-three patients with HL were recruited, and the prevalence of HIV-positive status was 27.7%. Most of the patients with HIV-HL had an age of > 30 years (73.9%), while most of the non-HIV-HL patients had an age of ≤ 30 years (63.3%) (P = 0.02). The 2-year OS rate for HIV-HL was 34%, while that for non-HIV-HL was 67%. Among the HIV-HL patients, predictors of a poorer outcome were a CD4 count ≤ 200 cells/mm3 (P = 0.05), lack of HAART use (P = 0.00), and the use of HAART for ≤ 10 months (P = 0.00).ConclusionThe prevalence of HIV-HL was 27.7% among HL patients. HIV positivity is still a poor prognostic factor in our setting, especially for patients not on HAART, on HAART for ≤ 10 months, or with a low CD4 count below 200 cells/mm3. Patients with HIV-HL were older and had higher LDH levels, whereas patients with non-HIV-HL were younger and had low LDH levels.

Prevalence of Chronic Kidney Disease and Associated Factors among HIV Patients in the Era of HAART in Ivory Coast: A Cross Sectional, Analytical Study

Background: Chronic kidney disease (CKD) may be common among HIV patients living in sub-saharan Africa due to the confluence of CKD risk factors and genetic predisposition. Preventive strategy through early detection and treatment has been advocated for CKD in Africa where majority of patients present late and cannot afford the cost of renal replacement therapy which is not widely available. The purpose of this study was to identify the prevalence and factors associated with CKD among HIV infected adults receiving HAART in a teaching hospital in Ivory Coast. Methods: This is a cross-sectional study of HIV patients on Highly Active Anti Retroviral Therapy followed at the HIV clinic of the medical out-patient department of the University teaching hospital of Bouaké from January to December 2021. CKD was defined as a serum creatinine-based estimated glomerular filtration rate ≤ 60 ml/min/1.73 m2. The collected data was analyzed by using Epi Info 2002 software. Results: Four hundred and two HIV-infected adults 18 years and over were recruited during the study period. We noticed 123 (30.6%) males. The mean age was 40 years. CKD was observed in 42 (10.44) patients infected-HIV. Eighty eight point three percent of patients had CD4 more than 500 cells. Low eGFR correlated with age more than 60 years old, worker in public sector, unemployed, no formal education and HIV type 2. Conclusion: Our study identified a prevalence of CKD of 10.44% by CKD EPI equations among HIV patients on HAART that attended the teaching hospital of Bouaké in Ivory Coast. Early screening and follow up of renal functions is important to minimize the risk of developing end stage kidney disease.

Oral Impacts on Daily Performances among People Living with Human Immunodeficiency Virus on HAART Era Attending Care and Treatment Clinics in Dar es Salaam, Tanzania

Oral disease/conditions are reported to have negative effects on the quality of life of People Living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (PLWHIV/AIDS). This study aimed to assess the prevalence and causes of oral impacts on daily performances (OIDP) and its associated factors among PLWHIV/AIDS. A cross-sectional study was conducted among 218 PLWHIV/AIDS attending two HIV Care and Treatment Centres (CTCs) in Dar es Salaam. The study utilized a structured interview schedule containing questions on socio-demography and a single item of global oral health measure on the perception of current oral health status (OHS). A Swahili version of an OIDP inventory was used to assess the impacts of oral conditions on participants’ daily performances. Frequency distribution, chi-square, and logistic regression analyses were conducted (p < 0.05). Participants’ age ranged from 20 to 70 years, mean of 41.15 SD 10.7. About 70% (n = 154) of the participants perceived their oral health status (OHS) as good. The prevalence of OIDP (³ 1) was 26.1% (n = 57). The most affected performances reported were eating and chewing food followed by maintaining the usual emotional state without being irritable. Toothache was the main cause of impacts on all daily performances except ‘speaking and pronouncing clearly’ which was caused by oral ulcer. Age (p = 0.025) and perceived oral health status (p = 0.000) were significantly associated with OIDP. More studies on biological and behavioural factors are recommended to support inclusion of oral health in CTCs.
 Keywords: Care and Treatment Centres; HAART; HIV; Oral health; Quality of life

2064. Incidence and Risk Factors for Microscopic Hematuria in a US Military HIV Cohort

Abstract Background Microscopic hematuria (MH) is a common finding on screening urinalyses in persons living with HIV (PLWH); however, a study in the pre-HAART era revealed that a complete urologic evaluation was generally non-diagnostic in young males with a benign history and normal renal function. Recent studies have shown a decreased incidence of hematuria in PLWH in the HAART era. We performed a nested case-control study in the prospectively enrolled US Military HIV Natural History Study (NHS) to evaluate characteristics of PLWH with and without MH. Methods We evaluated male participants diagnosed with HIV and enrolled in the NHS Jan 2007 to Dec 2019. MH cases were defined as having at least one urinalysis with ≥5 RBCs/hpf. We used descriptive statistics to compare cases and controls with respect to demographics, comorbidities, and laboratory findings to determine risk factors for MH. Cox regression models evaluated for independent associations with the development of MH since HIV diagnosis. Results Of 829 included participants, 142 (17.1%) had MH, of whom 87 (61.3%) had only one MH event. Cases had a shorter mean duration of study follow-up but more analyzable urinalyses per participant. There were no significant differences between cases and controls in demographics, CD4 count nadir, time from HIV diagnosis to HAART initiation, or inclusion of tenofovir disoproxil fumarate (TDF) in initial regimen. On univariate analysis, more cases had a history of urinary tract infection (UTI) or a hypertension diagnosis through the time of incident MH compared to controls, but were less likely to have proteinuria or pyuria at the time of MH. Cox regression models revealed that a history of UTI increased the hazard for MH (HR 2.07, p < 0.05). In contrast, the presence of proteinuria (HR 0.42, p< 0.01) and TDF use (HR 0.56, p< 0.05) decreased the hazard for MH compared to controls. Conclusion A history of UTI, though not concurrent pyuria, was associated with an increased hazard for MH. The use of TDF in the initial HAART regimen and the presence of proteinuria were protective against hematuria. Future studies are needed to clarify these findings; however, they provide reassurance that in a young, otherwise healthy cohort, MH is typically self-limited and unrelated to intrinsic renal pathology, comorbidity, or HIV-related factor. Disclosures All Authors: No reported disclosures.

Pneumonia and HIV Types: A Case Control Study in Gadarif State, Sudan

Background: Pulmonary infections remain one of the most important causes of morbidity and mortality among HIV patients, and the first cause of hospital admission in the HAART era. Achieving an etiological diagnosis of pulmonary infection in these patients is important due to its prognostic consequences. This is a case control study conducted at ART Center in Gedarif Teaching Hospital between the periods January 2020 to October 2021. Oro pharyngeal swabs were collected for isolation and identification of organisms from fifty HIV patients suffering from pneumonia with ages from 15 years old to 65 years old were included in this study to elicit the microorganism insulted to pneumonia among them. And also to detect types of HIV which are most associated with those pneumonic patients. Results: The results revealed that all pneumonic patients were type (1) HIV patients (100%), the most common microorganisms isolated were Staphylococcus auras (60%), Haemophilus influenzeae (20%), Pseudomonas aerugnosa (18%),and Streptococcus pneumonia (2%). Conclusion: This study indicated that all HIV patients are type 1, and revealed that the most common cause of pneumonia in HIV infected patients was Staphylococcus auras. So Accurate diagnosis, and appropriate treatment and prevention of HIV-associated opportunistic pneumonias is an important strategy for reducing the morbidity and mortality associated with HIV/AIDS.

Clinical Features, Phenotypic Markers and Outcomes of Diffuse Large B-Cell Lymphoma between HIV-Infected and HIV-Uninfected Chinese Patients.

Background: The effect of HIV infection on the clinicopathological characteristics of diffuse large B-cell lymphoma (DLBCL) remains debatable. Methods: Fifty-three HIV-infected and ninety-three HIV-uninfected DLBCL patients were enrolled in the retrospective study by propensity score matching for sex, age, body mass index and international prognostic index (IPI) at a ratio of 1:2. The clinicopathological characteristics were compared between the two groups. Results: HIV-infected DLBCL patients had lower white blood cell counts [×109/L; 4.4 (3.4-5.6) vs. 6.1 (4.2-8.2), p < 0.001], platelet counts (×109/L; 184.7 ± 89.3 vs. 230.0 ± 113.9, p = 0.014) and serum albumin (g/L; 37.3 ± 6.9 vs. 41.3 ± 6.2, p < 0.001) but higher incidences of central nervous system (CNS) involvement (9.4% vs. 1.1%, p = 0.014), bone marrow involvement (24.5% vs. 11.5%, p = 0.044) and Epstein-Barr viremia (61.1% vs. 26.7%, p = 0.002) than HIV-uninfected patients. In terms of histopathology, HIV-infected patients had higher positivity of Epstein-Barr virus-encoded small RNA (EBER) (41.7% vs. 6.7%, p = 0.002), but lower CD20 (90.2% vs. 98.7%, p= 0.029) and CD79a (23.1% vs. 53.7%, p < 0.001) expression. The overall response rate (ORR) at the end of chemotherapy (70.2% vs. 87.8%, p= 0.012) and 1-year overall survival (OS) (61.7% vs. 84.2%, log-rank p = 0.006) in HIV-infected patients were significantly lower than those in HIV-uninfected patients. Multivariate analysis suggested IPI ≤2.0 [adjusted odds ratio (AOR) (95% confidence interval): 5.0 (1.2-21.2), p = 0.030] was associated with ORR, hypoalbuminemia [AOR: 3.3 (1.3-9.1), p = 0.018] and CNS involvement [AOR: 3.3 (1.0-10.5), p = 0.044] were associated with reduced 1-year OS in HIV-infected patients. Conclusion: HIV-infected DLBCL patients have unique blood profiles and phenotypic markers. Low ORR and 1-year OS were observed in HIV-infected DLBCL patients in our study, even in the HAART era.

Sociodemographic predictors associated with the spectrum of non-opportunist neuroretinal disease of non-infectious etiology in patients with HIV/AIDS: A scoping review.

Non-infectious retinal disease, even in the HAART era, continues to be one of the most common diagnoses in patients with HIV, with prevalences of up to 27% of cases. This study aims to characterize the association between demographic variables and their role. As a risk factor for the development of non-opportunistic non-infectious retinal disease in patients with HIV/AIDS. An integrative review of the literature was carried out according to Arksey O'Malley's approach, based on the PICO methodology and following the PRISMA recommendations; An exhaustive search was carried out in databases of articles that were filtered using established criteria, with their extraction and analysis carried out qualitatively. Ocular manifestations from any cause develop from 35 years of age in patients with HIV/AIDS, with the highest risk for age-related macular degeneration over the fourth decade of life and for the development of neuroretinal disorder on the fifth decade of life; some studies report a slight tendency to diagnose macular degeneration in women and those who acquired AIDS through sexual contact; data contrasted with increased risk for diagnosing neuroretinal disorder in homosexual men who also use intravenous drugs, possibly due to oversampling in studies; non-Hispanic whites and African Americans were the races most commonly affected by neuroretinal disease; the means between the 11.3-14.5 years elapsed since the HIV diagnosis were more frequently associated with cognitive impairment and both in those with high or low CD4 counts, and in patients with high or low viral loads, neuroretinal disease without Statistically significant differences. Adherence and early initiation of HAART had a modest impact on the development of neuroretinal disease. Even in the HAART era, non-infectious neuroretinal disease and cytomegalovirus retinitis remain the most frequent ocular diagnoses, however, different studies argue an increase in age-related non-infectious retinal diseases in patients with HIV, theories that are may explain by the increase in life expectancy, the metabolic effects of HAART itself or the generalized pro-inflammatory state in this group of patients, it is essential to recognize this new diagnostic challenge in order to direct preventive efforts through the use of cost-effective sociodemographic risk predictors towards that technological tools for diagnosis and treatment can be targeted. HIV/AIDS patients who present at the ophthalmological consultation with the suggested sociodemographic predictors have a high risk of visual impairment due to non-infectious retinopathy, therefore prevention, diagnosis and treatment efforts directed at these diseases should be increased.

Dermatological Manifestations of HIV/AIDS Patients in the Era of HAART: Report from an ART Center of Chattogram

Introduction: Skin diseases are common striking features of HIV/AIDS patients and may vary considerably due to ethnic and geographic regions and currently by the influence of HAART also. However, there is a dearth of information in Bangladeshregarding the dermatological manifestations in HIV/AIDS patients. The purpose of this study is to find out the spectrum of cutaneous disorders in HIV/AIDS patients in the era of HAART. Materials and Methods: A descriptive cross-sectional study has been carried out to find the targeted results in the Chittagong Medical College Hospital, Bangladesh between the periods 2017 and 2020. Results: Of the 40 patients with HIV/AIDS, 22 (55%) were males and 18 (45%) were females. The age of the patients ranged from 8 to 60 years with mean age 38 (±0.966 SD) years. The age-specific cumulative HIV/AIDS cases at 31-40 years were high 19 (47.5%) among all age groups. The majority of the patients were migrant worker 22 (55%) with low socio-economic 32 (80%) background and common transmission mode was heterosexual 36 (90%). Most of the patients 32 (80%) had mucocutaneous disorders and Infective dermatoses accounted 30 (75%) and the non-infective inflammatory dermatoses were 21 (52.5%). Eight (20%) patients presented with 3 or more skin disorders. Common infective dermatoses were fungal infections 15 (37.5%) followed by viral infections 8 (20%), bacterial infections 4 (10%) and scabies 3 (7.5%). Common non-infective dermatoses were generalized pruritus 6 (15%) followed by prurigo simplex 4 (10%), psoriasis 4 (10%), eczema 3 (7.5%), pruritic papular eruption 1 (2.5%), seborrhoeic dermatitis 1 (2.5%), urticaria 1 (2.5%) and xerosis 1 (2.5%).Patients treated with HAART had decreased rates of oral candidiasis, herpes simplex, but increased rates of drug reactions 19 (47.5%). The most common drug eruption following HAART is morbiliform rash 11 (27.5%) and the commonest offending agent is nevirapine. The prevalence of mucocutaneous disorders were higher in patients with CD4 <200 cells/mm3. Conclusions: A wide range of skin disorders (80%) is observed in Bangladeshi HIV/AIDS patients and HAART had an impact on the spectrum of HIV/AIDS associated mucocutaneous disorders. They are seen at every stage of HIV/AIDS and are often the initial presentation in most instances within our environment. There is a need for increased attention to the diagnosis and treatment of skin diseases affecting the quality of life of HIV/AIDS patients.

Clinical Profile of 24 AIDS Patients with Cryptococcal Meningitis in the HAART Era: A Report from an Infectious Diseases Tertiary Hospital in Western Romania.

Management of cryptococcal infections among patients suffering from acquired immunodeficiency syndrome (AIDS) represents a medical challenge. This retrospective study aims to describe the disease management and outcomes among 24 AIDS patients who suffered from Cryptococcus neoformans meningitis. The parameters evaluated from our patients’ database records include epidemiological data, clinical manifestations, biochemical and microbiological analysis of patients’ cerebrospinal fluid (CSF), treatment profiles, and disease outcomes. All patients included in the study had a lymphocyte count of less than 200 CD4/mm3. Of the 24 patients included in this study, five had been diagnosed with HIV infection since childhood, after receiving HIV-infected blood transfusions. The most prominent symptom was fatigue in 62.5% of patients, followed by nausea/vomiting and headache. Seven patients had liver cirrhosis due to hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, while Kaposi sarcoma and cerebral toxoplasmosis were found in two patients. Six out of 24 patients died due to bacterial sepsis and acute respiratory distress syndrome (ARDS). High intracranial pressure was the strongest predictive factor for mortality (OR = 2.9), followed by ARDS (OR = 1.8), seizures at disease onset (OR = 1.4), and diabetes mellitus (OR = 1.2). Interestingly, patients younger than 40 years old had a significantly lower survival rate than that of the older patients. Before developing Cryptococcal meningitis, all patients had low adherence to the early ART treatment scheme and skipped the follow-up visits. All patients received a combination of amphotericin B and flucytosine as induction therapy, adding fluconazole for maintenance. Simultaneously, AIDS HAART was initiated at diagnosis of the cryptococcal infection. A combined regimen of antifungals and highly active antiretroviral therapy showed improved patient recovery with minor side effects.

Bone marrow examination of HIV-infected children in HAART era reveals a spectrum of abnormalities: a study from single tertiary care center of North India

Pediatric HIV is a significant contributor to childhood morbidity and mortality. As HIV infects bone marrow CD34-positive progenitor cells, the hematological abnormalities are well-expected. The viral load is much higher in children predisposing them to opportunistic infections and hematopoietic malignancies. The present study aimed to determine the spectrum of hematological abnormalities that may yield clinically useful information in HIV-infected children. This was a retrospective study of 19 HIV-infected children who underwent bone marrow examination. Overall, 20 peripheral blood and bone marrow samples were analyzed for morphological changes in all hematopoietic lineages. Immunohistochemistry was performed on trephine biopsy sections for evaluation of B and T cells and cytomegalovirus inclusions. Anemia was the most common cytopenia (95%), followed by thrombocytopenia (45%) and leukopenia (40%). Myelodysplasia was noted in 70% of cases. Dysmegakaryopoiesis was predominant in 65% of cases, while dyserythropoiesis was noted in 25% of cases. Hemophagocytosis and reactive cellular changes were noted in 20% of cases each. Benign lymphoid aggregates and granulomatous inflammation were observed in 15% and 10% of cases, respectively. Significant myelofibrosis was found in 35% of cases. One case showed infiltration by Burkitt lymphoma. Parvoviral inclusions were identified in 1 case. An interstitial increase and aggregates of CD8 + T cells and reduced CD4 + T cells were noted. CD20 + B cells were normal to mildly increased in the bone marrow. Bone marrow examination provides clinically significant information in pediatric HIV revealing the underlying cause of hematopoietic abnormalities and allows the exclusion of major hematological neoplasms.

Factors Associated With Quality Of Life People Living With Hiv/Aids At Yayasan Peduli Kelompok Dukungan Teman Sebaya (YPKDS) In Makassar City

In the current era of HAART, PLWHA can live longer, but that does not mean they lived a satisfying and quality life. This makes PLWHA vulnerable to various health problems.Thus, the aim of this study is to see factors that may associate with the quality of life people with HIV/AIDS. This research was using a cross sectional study. The selected location was YPKDS Makassar with total sample 67 respondents. The sociodemographic analyses found that mostly respondents were male. Most of the respondent were Islam (89,6%), single (58,2%), and living together with their closest family members (62.7%). The respondents mostly have a job and most of them already under medication for less than or in 2 years. Gender, period on medication and stigma were associate with quality of life people with HIV/AIDS. The conclusion was there were several factors that associate with quality of life and need to be analyzed further.

Predictores sociodemográficos asociados al espectro de enfermedad neurorretiniana no oportunista de etiología no infecciosa en pacientes con VIH/SIDA: revisión integrativa

BackgroundNon-infectious retinal disease, even in the HAART era, continues to be one of the most common diagnoses in patients with HIV, with prevalences of up to 27% of cases. This study aims to characterize the association between demographic variables and their role. as a risk factor for the development of non-opportunistic non-infectious retinal disease in patients with HIV/AIDS MethodsAn integrative review of the literature was carried out according to Arksey O’Malley's approach, based on the PICO methodology and following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) recommendations; An exhaustive search was carried out in databases of articles that were filtered using established criteria, with their extraction and analysis carried out qualitatively. ResultsOcular manifestations from any cause develop from 35 years of age in patients with HIV/AIDS, with the highest risk for age-related macular degeneration over the fourth decade of life and for the development of neuroretinal disorder on the fifth decade of life; some studies report a slight tendency to diagnose macular degeneration in women and those who acquired AIDS through sexual contact; data contrasted with increased risk for diagnosing neuroretinal disorder in homosexual men who also use intravenous drugs, possibly due to oversampling in studies; non-Hispanic whites and African Americans were the races most commonly affected by neuroretinal disease; the means between the 11.3 to 14.5 years elapsed since the HIV diagnosis were more frequently associated with cognitive impairment and both in those with high or low CD4 counts, and in patients with high or low viral loads, neuroretinal disease without Statistically significant differences. Adherence and early initiation of HAART had a modest impact on the development of neuroretinal disease. DiscussionEven in the HAART era, non-infectious neuroretinal disease and cytomegalovirus retinitis remain the most frequent ocular diagnoses, however, different studies argue an increase in age-related non-infectious retinal diseases in patients with HIV, theories that are may explain by the increase in life expectancy, the metabolic effects of HAART itself or the generalized pro-inflammatory state in this group of patients, it is essential to recognize this new diagnostic challenge in order to direct preventive efforts through the use of cost-effective sociodemographic risk predictors towards that technological tools for diagnosis and treatment can be targeted. ConclusionsHIV/AIDS patients who present at the ophthalmological consultation with the suggested sociodemographic predictors have a high risk of visual impairment due to non-infectious retinopathy, therefore prevention, diagnosis and treatment efforts directed at these diseases should be increased.

Cytomegalovirus retinitis in post HAART era in the north eastern India

Cytomegalovirus retinitis in post HAART era in the north eastern India - IJCEO- Print ISSN No: - 2395-1443 Online ISSN No:- 2395-1451 Article DOI No:- 10.18231/2395-1451.2018.0084, Indian Journal of Clinical and Experimental Ophthalmology-Indian J Clin Exp Ophthalmol

HIV-associated plasmablastic lymphoma in the era of HAART: a single-center experience of 21 patients: Erratum.

HIV-associated plasmablastic lymphoma in the era of HAART: a single-center experience of 21 patients: Erratum.

Causes of hypercalcemia in people living with HIV in the HAART era

Background Hypercalcemia is an uncommon finding in people living with HIV (PLHIV). Causes of hypercalcemia in PLHIV have not been well documented. As such, we studied the causes of hypercalcemia in PLHIV. Methods We conducted a retrospective review of PLHIV who had corrected serum calcium of ≥10.5 mg/dL between 2010 and 2019. Demographic data, associated diseases, and treatment details were collected. Corrected serum calcium levels were compared among the causes of hypercalcemia. Results A total of 70 of 2168 (3.2%) PLHIV had hypercalcemia. Forty-nine (70.0%) were male with a mean age of 47.7 ± 4.7 years. Only two (2.9%) had symptoms of hypercalcemia. Fifty-four patients had identifiable causes of hypercalcemia; 21 infections (30.0%), 17 solid organ malignancies (24.3%), 14 hematologic malignancies (20.0%), and two other specific causes (2.9%). Mean corrected serum calcium concentrations of PLHIV who had solid organ malignancy, hematologic malignancy, infection, and unknown causes were 12.8 ± 2.1, 11.4 ± 1.0, 11.2 ± 0.6, and 10.8 ± 0.2 mg/dL, respectively. Corrected serum calcium levels were significantly greater in patients who had solid organ malignancy comparing to those with other causes of hypercalcemia (p < 0.05, all). Logistic regression identified solid organ malignancy as the only factor associated with moderate to severe hypercalcemia (odds ratio 12.72, 95% confidence interval 3.11–52.08; p < 0.001). Conclusions Hypercalcemia in PLHIV is associated with solid organ malignancy, hematologic malignancy, and infection. Most PLHIV with hypercalcemia are asymptomatic. Solid organ malignancy is associated with moderate to severe hypercalcemia, and as such PLHIV presenting with moderate to severe hypercalcemia should be investigated for solid organ malignancy.

Opportunistic Cryptococcal Antigenemia in the HAART Era at HIV Epidemic Settings of Northwest Ethiopia.

Background Cryptococcus neoformans is a frequent opportunistic infection in patients with the acquired immunodeficiency syndrome. While the advent of ART reduces the occurrence of cryptococcal meningitis in HIV patients, cryptococcal disease remains a leading cause of morbidity and mortality in the developing world especially in sub-Saharan Africa which is the epicenter of HIV. This study aimed to assess the cryptococcal antigenemia, CD4+ Th cell counts, HIV RNA viral load, and clinical presentations among HIV-positive patients in Northwest Ethiopia. Method A total of two hundred (200) HIV-positive patients were recruited for this study. Cryptococcus antigenemia prevalence in plasma samples of HIV‐positive patients was determined by using Antigen lateral flow assay (CrAg‐LFA) also, and CD4+ Th cell counts and HIV‐RNA levels were quantified from blood specimen. Patients' demographic data, clinical manifestation, and concurrent opportunistic infection were recorded. Result The sex distributions of study participants were 105(52.5%) male and 94(47.5%) female with an age range of 15–65 (mean 39.42 ± 9) years. All patients had a CD4+ T-cell count <100 cells/µl with the median 54 cells/μl and median HIV-RNA viral load 2.16 × 105 RNA copies/ml (50–3.66 × 105 RNA copies/ml); the prevalence of cryptococcal antigenemia was found to be 4% in HIV-positive patients. More than half and two third of CrAg‐positive patients had a CD4 count <25 cells/μl and HIV viral load >10,000 copies/ml, respectively, as well; Tuberculosis, Candidiasis, and herpes zoster are the most often observed concurrent infections while cryptococcal antigenemia is significantly associated with oral candidiasis (p < 0.001). Conclusion Although the advent of ART, early diagnosis of cryptococcosis, and application of antifungal interventions, HIV-induced cryptococcal antigenemia positivity in HIV infected individuals is still the countries' big challenge. Thus, stringent follow-up and case management should be considered.

HIV-associated plasmablastic lymphoma in the era of HAART: a single-center experience of 21 patients.

Patients with HIV infection have an increased risk of developing plasmablastic lymphoma (PBL). In this study, we reviewed the clinicopathologic features of PBL in HIV+ patients in the era of HAART from a single health center. Retrospective study. The morphologic, immunophenotypic, and clinical features were reviewed in these HIV+ patients with PBL and univariate analysis was employed to determine the survival prognosis. During the interval of 1 January 2008 to 30 December 2018, we identified 95 HIV+ patients with aggressive non-Hodgkin B-cell lymphomas. Among these patients, there were 21 (22%) patients with PBL (19 men and two women; median age: 45 years). Seven patients had PBL at their initial HIV diagnosis and 14 developed PBL after a median interval of 7.7 months of HIV diagnosis. Lymph nodes (n = 10), oral cavity/sinonasal mass (n = 6), and rectal masses (n = 5) were the common involved sites, and five of 15 (33%) had bone marrow involvement. Lymphoma cells were immunoreactive for MUM-1/IRF4 (100%), CD138 (90%), CD45 (63%), CD79a (47%), and CD30 (25%). Proliferation rate assessed by Ki67 was at least 90% in 18 of 20 cases. Eighteen patients received chemotherapy including etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (n = 13) and cyclophosphamide, doxorubicin, vincristine, and prednisone (n = 2). With a median follow-up time of 19 months, nine out of 17 patients died. Bone marrow involvement was associated with a poorer overall survival (median: 4.7 months, P = 0.015). PBL is the second most common type of aggressive lymphoma and often presents in lymph nodes of patients with poorly controlled HIV infection. Bone marrow involvement is associated with a poorer outcome.

Ocular Findings in HIV-Positive Children in Two Hospital Facilities in Yaoundé, Cameroon

Background: HIV infection in children as well as adults remain a disease with potential multisystemic disorders despite the increased use of Highly Active Antiretroviral Therapy (HAART). The aim of this work was to determine the profile of eye diseases among HIV-positive children aged 5 to 15 years in the Mother and Child Centre of the Chantal Biya Foundation and the University Hospital Centre (UHC) in Yaounde. Materials and Methods: an analytical study was conducted from June 1, to July 31, 2019. Our sample consisted of all children aged 5 - 18 years who were HIV positive and whose parent or legal guardian gave his or her consent. A complete clinical examination was performed. The following variables were collected: socio-demographic data, Immunological data. A comprehensive eye exam was also performed. Data were analysed by the Epi info 3.5.4 software. Results: A total of 53 children were retained for the study. The population consisted of 28 boys (52.3%), for a sex ratio of 1.12. The mean age was 12.7 ± 4.2 years [5 - 18 years]. And 84.9% of children had normal immune status. The average duration of HAART was 8.3 ± 3.9 years [0 to 16 years] with more than half (50.9%) of the children on treatment for more than 8 years. The main eye complaints were pruritus (11.32%), eye pain (11.32%) and tingling (9.43%). The frequency of ophthalmological manifestations was 52.8% with adnexal involvement the most frequent (34%), followed by anterior (7.5%) and posterior segment involvement (1.9%). Anterior segment involvement was marked by granulomatous anterior uveitis, keratouveitis and corneal ulcer. A cytomegalovirus retinitis and a macular scar of a unilateral retinitis were found in 2 patients. In a multivariate analysis, elevated CD4 count (>500) was associated with ocular manifestations. Conclusion: In the HAART era, an ocular examination is mandatory to prevent harmful eye diseases among children because ophthalmological diseases remain frequent. Although they are most often lesions of the annexes, corneal and chorioretinal involvement can be detrimental for the vision.

Ocular Manifestations in Human Immunodeficiency Virus Patients in the Pre-HAART and HAART Era

The human immunodeficiency virus infection causes a wide range of ocular manifestations. It is a growing concern in the developing countries. Now, the government provides the highly active antiretroviral therapy free of cost. But ocular manifestations continue to arise in patients with Human Immunodeficiency Virus infection. Hence a comparitive analysis of the disease pattern is important in assessing the ocular manifestations in the pre–HAART and HAART era. The aim of this retrospective series is to analyse the ocular manifestations in Human Immunodeficiency Virus patients in the pre-HAART and HAART era This retrospective study includes Human Immunodeficiency Virus positive patients from the pre-Highly Active Antiretroviral Therapy (HAART) (1995-2000) and HAART era (2005-2017). Patients were assessed for the ocular manifestations. This study included 83 patients in the pre HAART era and 98 patients in the HAART era. Cytomegalovirus retinitis was the most common ocular manifestation in the pre-HAART and the HAART era. Inspite of free availability of the antiretroviral therapy, the results of our study has not shown a reduction in the ocular manifestations in the HAART era. Awareness among the high risk population, screening of population at community health centers, private health sectors and engaging non-government organizations for awareness in the community can help in early diagnosis of HIV. This may cause a reduction in the ocular manifestations in individuals with Human Immunodeficiency Virus.

1255. Comparison in AIDS-Related Mortality Between African Americans and Whites with Human Immunodeficiency Virus During the HAART Era

BackgroundHigher death rates have been reported in African American (AA) compared with non-Hispanic whites with HIV infection. However, there are no published studies of attributable mortality by racial and ethnic groups. We evaluated differences in attributable mortality between AA and whites.MethodsWe conducted a retrospective review of all persons with HIV infection who received care at the University of Cincinnati Medical Center whose deaths were between 1996 and 2017. We abstracted chart data using a standard data tool and identified all deaths reported to the social security national database. Probable cause of death was assigned using the EuroSida CoDe methodology. Primary endpoint was to compare AIDS vs. non-AIDS-related deaths between AA and whites.ResultsInitial analysis of 588 deaths are reported through 2007 (44% AA and 53% white). The median age at the time of HIV diagnosis was 37 years for AA patients and 36 years for white patients, while median age at the time of death was 43 years for AA and 42 years for whites (P = ns). 16.9% of AA were women, 2.6% were transgender; 10.3% of whites were women and 1% were transgender (P < 0.02). Risk factors for HIV acquisition included: MSM, 61.3% of whites vs. 46.0% AA; heterosexual contact, 11.7% of whites vs. 13.4% for AA; and injection drug use 16.9% white vs. 18.3% AA (P < 0.0001). African Americans had both lower median CD4 counts at the time of diagnosis and within 3–6 months prior to death (167 and 68 cells/mm3, respectively) as compared with whites (214 and 103 cells/mm3, respectively) (P < 0.0001 for both). There was no statistical significance of having AIDS at entry into the practice between AA and whites (P = 0.79). AIDS-related deaths accounted for a larger percentage of overall deaths within white patients (51%) compared with AA patients (40%) (P = 0.03).ConclusionOur data show that while a greater percent of AIDS-related deaths were found in whites vs. AA in the early HAART era, AA patients typically have lower CD4 counts at the time of diagnosis and within 3–6 months prior to death. Future analyses will examine specific attributable mortality, HIV viremia and changes in causes of death over later HAART era. Understanding factors associated with mortality may inform care models to prevent or delay future deaths.Disclosures All authors: No reported disclosures.