Higher HIV Viral Load Research Articles

HIV-Malaria co-infection and its determinants among patients attending antiretroviral treatment clinic in Zaria, Kaduna State, Nigeria

Background: Malaria and HIV are two important global public health problems. Together, they cause more than two million deaths each year. In sub-Saharan Africa alone, more than 29 million people are living with HIV/AIDS and about 70% of population is at risk to malaria infection. Nigeria accounts for about a quarter of the global malaria cases and tenth of the global HIV cases. Recent theories suggested possibilities of high occurrence of HIV-malaria co-infection wherever there is geographical overlap of the two diseases. We therefore conducted this study to determine the prevalence of HIV-malaria co-infection and its determinants in a malaria endemic setting. Methods: We conducted a cross-sectional study. Two hundred and sixty-two clients attending antiretroviral treatment (ART) clinic in Zaria, Kaduna State were enrolled between February and April 2018 using systematic sampling technique. Questionnaires were administered to collect information on respondents’ personal characteristics and to assess their knowledge, perception and practices on malaria prevention. Venous blood samples were collected and analyzed for malaria parasite, viral load, CD4, and FBC using Giemsa stained light microscopy, COBAS TaqMan equipment, BD FACS™ flow cytometer, and Sysmex haematology analyser respectively. Descriptive and inferential statistics were performed, predictors of HIV-malaria co-infection were ascertained at multivariate analysis. Results: Median age of the respondents was 33 years, 52% were females, 65% were married, 65% were employed, 57% lived in urban residence, and 34% had tertiary education. The prevalence of malaria co-infection among HIV patients was found to be 22.9%. Significant risk factors for the co-infection were high HIV viral load (aOR= 3.30, C.I = 1.15-9.45), being co-infected with TB (aOR= 5.60, C.I = 1.34-23.33), poor knowledge of malaria infection (aOR= 3.12, C.I = 1.27-7.72) and poor practice of malaria prevention (aOR= 13.30, C.I = 4.88-36.23). Conclusion: The level of occurrence of malaria among HIV infected patients in this setting calls for attention. We recommended that health education on malaria should be a priority in malaria control programme; the programmes for control of HIV, malaria and TB should collaborate to ensure integrated service delivery and that people living with HIV/AIDS should be given special consideration for malaria prevention.

926. Antibody Response to HPV Vaccination in Pediatric and Adolescent People Living with HIV (PLWH)

BackgroundImmune dysfunction related to HIV infection is associated with an inability to clear HPV infection and may compromise the immunogenicity of quadrivalent HPV vaccine Gardasil® (4v HPV).MethodsBetween 2005 and 2017, males and females 7 to 20 years old age, were offered 3-dose 4v HPV vaccine. Plasma IgG titers to HPV 6 (H6), 11 (H11), 16 (H16) and 18 (H18) were measured using multiplex VLP-based ELISA. For the 36 patients, median interval from 1st dose to 2nd and 3rd doses were 73 and 216 days. Plasma sample 1 was collected at median of 91 days after dose 1, sample 2, 169 and sample 3, 740 after respective vaccine doses. A 4th sample was available for 26 patients, median 2327 days after dose 1. Rank-sum test, Χ 2 or Fisher’s Exact Test were employed.ResultsBefore vaccination, 10 (28%) were seropositive to 1 or more HPV types. The baseline seropositives were older than seronegatives (16 years vs 11; p=0.007). After dose 3 all participants had an Ab response to at least 1 HPV type and 32 (89%) were seropositive for 4 HPV types. Seroconversions were H18, 87%; H16 97%; H11, 100%; H6, 97%. Seroconversions after 1 dose of 4v HPV among the baseline seronegatives were 61%, 90%, 86% and 86%, respectively and 22 became seropositive for all 4 types. The 4 baseline seronegative PLWH with partial seroconversion had higher median HIV viral load (VL) compared to baseline seronegative group with full seroconversion (12,920 vs 101 copies/ml; p = 0.052), but had comparable CD4 counts. The rate of post vaccination seropositivity and baseline to peak titer response for each HPV type was not significantly different for baseline sero-groups. Among baseline seronegative, all 19 sampled distant from vaccination remained seropositive to at least 1 HPV type (84% to 3 or more types) and 6 (32%) became seronegative (sero-reversion). Those showing sero-reversion had higher VL compared to the 14 who remained seropositive (9100 vs 48; p =0.015). Time from last dose of 4v HPV to sample 4, CD4%, age, gender, and race/ethnicity were similar between the groups.Bar Graphs representing Ab response to the 4 HPV types following each dose of 4v HPV vaccine ConclusionIn the complex environment of a pediatric HIV specialty clinic, most PLWH mounted Ab responses to 4v HPV that were durable. H18 was least immunogenic. Patients with higher HIV VL were less likely to seroconvert for all types and were more likely to sero-revert.Disclosures All Authors: No reported disclosures

950. Venous Thromboembolism in Persons Living with HIV (PLWH): A Single Center Retrospective Cohort Study

BackgroundData on risk of thromboembolism in PLWH is limited. HIV is often recognized as a chronic inflammatory disease and has been recognized as a prothrombotic condition. We aimed to analyze the incidence and demographic of venous thromboembolism such as pulmonary embolism and deep vein thrombosis in PLWH admitted to our hospital.MethodsWe conducted a retrospective hospital cohort study on PLWH ≥ 18 years old who were admitted to our hospital between 09/01/2018 and 09/01/2019. Study individuals were recruited if they had complete laboratory profile and well-defined clinical outcomes. Demographic, clinical and laboratory data were reviewed and retrieved. Descriptive analysis was employed to describe the demographic profile of PLWH with venous thromboembolism.ResultsOut of the 192 hospitalized PLWH during the study period, 15 (8%) patients had documented deep vein thrombosis (DVT) and/or pulmonary embolism (PE). History of DVT/PE was present in 5 (33%) patients while the rest had new onset of DVT/PE. Out of the 15 patients, 4 (27%) had DVT and PE, 4 (27%) had only DVT and 7 (46%) had only PE. The median age was 57 years, ranged from 40 to 74 years; 4 males and 11 females. As for ethnicities, 2 Caucasian, 12 were African American and 1 Hispanic.The average D-dimer was 4491. The median CD4 count for PLWH with venous thromboembolism was 487 and a median viral load of 900. In contrary, the median CD4 count of PLWH without venous thromboembolism was 420 and median viral load of 140. Though not statistically significance, higher viral load seems to associate with risk of venous thromboembolism. Surprisingly, female gender is an independent risk factor for venous thromboembolism in PLWH (z-score 2.75, p=0.0059; odds ratio [OR], 4.67; 95% confidence interval [CI], 1.56-13.69).ConclusionOur observation of PLWH with venous thromboembolism suggest that this population has an increased risk of venous thromboembolism as compared to general population. Female gender is an independent risk factor for venous thromboembolism in PLWH and higher HIV viral load seems to associate with higher risk. Larger prospective studies in this population are needed to dissect the interplay between HIV and venous thromboembolism.Disclosures All Authors: No reported disclosures

Association of Adverse Neighborhood Exposures With HIV Viral Load in Pregnant Women at Delivery

Racial disparities in maternal morbidity and mortality are in large part driven by poor control of chronic diseases. The association between adverse neighborhood exposures and HIV virologic control has not been well described for women with HIV during pregnancy. To evaluate the association between adverse neighborhood exposures and HIV viral load at delivery. This population-based cohort study assessed HIV surveillance data for pregnant women with HIV who had live deliveries in Philadelphia from January 1, 2005, through December 31, 2015. Data analyses were completed in August 2020. Neighborhood exposures included extreme poverty, educational attainment, crime rates (using separate and composite measures), and social capital categorized above or below the median. Each neighborhood exposure was modeled separately to estimate its association with elevated HIV viral load. The main outcome was elevated HIV viral load of ≥200 copies/mL at delivery. We hypothesized that adverse neighborhood exposures would be associated with higher odds of having an elevated viral load at delivery. Confounders included birth year, age, race/ethnicity, previous birth while living with HIV, and prenatal HIV diagnosis. Prenatal care and substance use were considered potential mediators. We used logistic mixed effects models to estimate the association between neighborhood exposures and elevated viral load, adjusting for confounders in Model 1 and confounders and mediators in Model 2. There were 905 births among 684 women with HIV, most of whom were aged 25 to 34 years (n = 463 [51.2%]) and were Black non-Hispanic (n = 743 [82.1%]). The proportion of women with elevated viral load decreased from 58.2% between 2005 and 2009 to 23.1% between 2010 and 2015. After adjusting for confounders in Model 1, higher neighborhood education was associated with lower odds of having an elevated viral load (adjusted odds ratio [AOR], 0.70; 95% CI, 0.50-0.96). More violent crime (AOR, 1.51; 95% CI, 1.10-2.07), prostitution crime (AOR, 1.46; 95% CI, 1.06-2.00), and a composite measure of crime (AOR, 1.44; 95% CI, 1.05-1.98) were positively associated with having a higher HIV viral load. These associations remained after adjusting for mediators in Model 2. In addition, the AOR for intermediate prenatal care varied between 1.93 (95% CI, 1.28-2.91) and 1.97 (95% CI, 1.31-2.96), whereas the AOR for inadequate prenatal care varied between 3.01 (95% CI, 2.05-4.43) and 3.06 (95% CI, 2.08-4.49) across regression models. In this cohort study, adverse neighborhood exposures during pregnancy and poor engagement in prenatal care were associated with poor virologic control at delivery. These findings suggest that interventions targeted at improving maternal health need to take the social environment into consideration.

Returning of antiretroviral medication dispensed over a period of 8\xa0months suggests non-adherence despite full adherence according to real time medication monitoring

Real-time medication monitoring (RTMM) may potentially enhance adherence to antiretroviral treatment (ART). We describe a participant in an ongoing trial who, shortly after completing trial participation, died of cryptococcal meningitis despite high levels of adherence according to self-report, pill-counts and RTMM (> 99%). However, she evidenced consistently high HIV viral load throughout the 48-week study follow-up. Subsequently, her relatives unsolicitedly returned eight months’ dispensed ART medication that she was supposed to have taken. This brief report illustrates the challenges of adherence measurements including RTMM, and reinforces the need to combine adherence assessments with viral load monitoring in HIV care.

Cytomegalovirus (CMV) infection in HIV/AIDS patients and diagnostic values of CMV-DNA detection across different sample types.

Cytomegalovirus (CMV) is a common herpesvirus that has spread throughout the human population. It can easily cause organ damage in individuals who are immunocompromised. While many studies have examined the virology and immunology of simple CMV infection, few articles have described the unique immunological features of patients with HIV-CMV coinfection. CMV infection was detected in 808 HIV/AIDS inpatients in our center from January 2017 to October 2019, and the relevant data from these patients were retrospectively analyzed. HIV-RNA, CD4+ T lymphocyte count, CMV-DNA, and related antibodies were measured in all patients. The positive rates of CMV-DNA in blood, urine, and cerebrospinal fluid (CSF) were compared. The positive rates between anti-CMV-immunoglobulin M (IgM) antibody and CMV-DNA in blood were compared. The correlation between immune status and CMV positive rate was analyzed based on the CD4+ T lymphocyte count. The overall positive rate of CMV infection in HIV/AIDS patients was 29.05%. The positive rate of CMV-DNA in urine, blood, and CSF samples was 25.27%, 26.01%, and 5.70%, respectively, and showed no significant difference between urine and blood. However, plasma CMV-IgM antibody level was significantly different between the urine and blood. The absolute CD4+ T lymphocyte count and the HIVRNA level were significantly different between the CMV-infected group and the non-CMV infected group. Low CD4+ T lymphocyte count and high HIV-1 viral load are risk factors for CMV infection in HIV/AIDS patients. Detection of urine or plasma CMV-DNA by using real-time fluorescence quantitative polymerase chain reaction (PCR) is highly valuable in screening CMV infection in HIV/AIDS patients, while detection of blood CMV IgG and CMV IgM levels has limited clinical value.

Epidemiological, Virological and Serological Features of Coronavirus Disease 2019 (COVID-19) Cases in People Living With Human Immunodeficiency Virus in Wuhan: A Population-based Cohort Study.

BackgroundWe aimed to describe the epidemiological, virological and serological features of coronavirus disease 2019 (COVID-19) cases in people living with HIV (PLWH).MethodsThis population-based cohort study identified all COVID-19 cases among the whole PLWH in Wuhan city, China, by April 16, 2020. The epidemiological, virological and serological features were analyzed based on the demographic data, temporal profile of nucleic acid test for SARS-CoV-2 during the disease, and SARS-CoV-2-specific IgM and IgG after recovery.ResultsFrom January 1 to April 16, 2020, 35 of 6001 PLWH have experienced COVID-19, with the cumulative incidence of COVID-19 to be 0.58% (95%CI: 0.42%-0.81%). Among the COVID-19 cases, 15 (42.86%) had severe illness, with 2 deaths. The incidence, case-severity and case-fatality of COVID-19 in PLWH were comparable to that in the entire population in Wuhan. 197 persons had cART discontinuation, of whom 4 persons experienced COVID-19. Risk factors for COVID-19 were age ≥50 years old and cART discontinuation. The median duration of SARS-CoV-2 viral shedding among confirmed COVID-19 cases in PLWH was 30 (IQR: 20-46) days. Cases with high HIV viral load (≥20 copies/ml) had lower IgM and IgG levels than those with low HIV viral load (<20 copies/ml) (median S/CO for IgM, 0.03 vs. 0.11, P<0.001; median S/CO for IgG, 10.16 vs. 17.04, P=0.069).ConclusionsEfforts need to maintain the persistent supply of antiretroviral treatment to elderly PLWH aged 50 years or above during the COVID-19 epidemic. The coinfection of HIV and SARS-CoV-2 might change the progression and prognosis of COVID-19 patients in PLWH.

HIV-1-Syphilis Co-infection Associated with High Viral Load in Female Sex Workers in the Democratic Republic of the Congo

Background: Sexually transmitted infection (STI) and HIV co-infection are common in countries where resources are limited constituting a leading public health issue. The negative impact of HIV transmission and acquisition are known. The aim of this study was to determine whether HIV-1-syphilis co-infection is associated with high HIV-1 viral load (VL) in female sex workers (FSWs) in the Democratic Republic of the Congo (DRC).&#x0D; Methods: Sera from 411 FSWs tested HIV+ in a national, DRC HIV/STI Integrated Biological and Behavioral Surveillance Survey (IBBSS) conducted between December 2012 and January 2013. HIV and syphilis testing were performed according to validated DRC national testing algorithms used by the national HIV-AIDS and STI program (PNLS). VL was measured according to Abbot m2000sp and m2000rt protocols. HIV-1-syphilis co-infection proportion was determined and multivariate analyses were used to identify factors associated with higher VL in HIV-1-syphilis co-infected FSWs.&#x0D; Results: Of 411 HIV-infected FSWs, 19.2% (95% CI: 15.4 – 23.0) were co-infected with syphilis. The mean HIV-1 VL in HIV-1-positive FSWs co-infected with syphilis [2.9 log10 HIV RNA/mL (95% CI: 2.49 – 3.29)] was higher compared with those not co-infected with syphilis [2.2 log10 HIV RNA/mL (95% CI: 1.97 – 2.46)]. Multivariate analysis showed that syphilis co-infection was associated with high HIV-1 VL (aOR [95% CI] = 1.90 [1.03, 3.52]) but HIV-1 VL was not influenced by age, education level, duration in sex profession, abnormal fluid, and sore to sex.&#x0D; Conclusion and Implications for Translation: HIV-1 – Syphilis co-infection was associated with higher HIV-1 VL. Preventing FSWs from getting STIs and screening HIV infected individuals for STIs and providing them with appropriate treatment could impact the transmission of HIV from FSWs to their clients.&#x0D; Keywords: • HIV-1 • Syphilis • Co-infection • Viral load • Female sex workers • DRC&#x0D; &#x0D; Copyright © 2020 Musema et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

HIV-associated Extracranial Arterial Aneurysms: A Systematic Review

Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has been found to be associated with an increased risk of cardiovascular disease, and the development of arterial aneurysms in particular, intracranial aneurysms. In this review, we will review the reported HIV-associated extracranial aneurysms (HECAA) and their possible association with HIV/AIDS. We will discuss the proposed pathogenetic pathways leading to arterial aneurysms. HECAA, a subset of HIV/AIDS-associated arterial aneurysm (HAA), is more commonly seen in the adult population and in those with lower CD4+ T-cell counts and higher HIV viral loads. There also appears to be an advantage to early diagnosis of HECAA. There are viable treatment options available, as 61.4% of patients with HECAA underwent a corrective procedure. Furthermore, the mortality rate of 1.75% in HECAA was much lower when compared to HICAA.

Role of Glutathione S-Transferase (&amp;lt;i&amp;gt;GSTM&amp;lt;/i&amp;gt;1 and &amp;lt;i&amp;gt;GSTT&amp;lt;/i&amp;gt;1) Genes Deletion in Susceptibility to HIV-1 Disease Progression

Background: Glutathione S-transferases (GSTs) are multifunctional enzymes which play an important role in oxidative stress pathways by conjugation with glutathione. Oxidative stress is one of several risk factors that may be associated with many types of diseases progression such as cancer and infectious diseases. In this study, we investigated the association between the polymorphism of GSTM1 and GSTT1 genes and the risk of HIV-1 disease progression. Methods: We conducted a case-control study including 313 participants of Burkina Faso: 153 HIV-1 infected individuals on antiretroviral treatment (ART) and 160 HIV-1 negative individuals as controls. Presence or absence of the GSTM1 and GSTT1 genes was determined using multiplex polymerase chain reaction (PCR). CD4+ T counts and HIV-1 viral load were measured in patients using respectively BD FACSCount and Abbott m2000rt instruments. Results: Frequencies of GSTM1-null and GSTT1-null were 30.35% and 35.46% respectively and the frequency of double deletion GSTM1-null/GSTT1-null was 14.38% in the general study population. GSTM1-null (30.35% versus 69.65%; OR = 1.90; p = 0.010), GSTT1-null (35.46% versus 64.54%; OR = 3.11; p GSTM1-active/GSTT1-null (21.08% versus 48.56%; OR = 3.17; p GSTM1-null/GSTT1-null (14.38% versus 48.56%; OR = 4.46; p GSTM1-null and GSTM1-null/GSTT1-null were associated with increased odds of low CD4+ count (3) and high HIV-1 viral load (≥1000 copies/mL). Conclusion: GSTM1-null, GSTT1-null genotype, the double genotypes GSTM1-active/GSTT1-null and GSTM1-null/GSTT1-null were associated with HIV-1 disease progression and GSTM1-null and GSTM1- null/GSTT1-null genotypes were associated with low CD4+ T cells counts and high HIV-1 viral load in HIV-1infected patients on ART.

ORAL KAPOSI SARCOMA IN PATIENTS WITH ACQUIRED IMMUNODEFICIENCY SYNDROME: CASE REPORTS

AIDS associated with Kaposi sarcoma (KS-AIDS) is one of the most prevalent malignant neoplasms in people with HIV. It usually presents initially as violaceous cutaneous lesions, but oral mucosa, lymph nodes, and visceral organs may be affected, sometimes without skin involvement, being an important prognostic factor. The aim of this presentation is to report 4 KS-AIDS cases with oral involvement. All cases occurred in black or mixed-race men, aged between 23 and 31, showing extremely low CD4 counts (range, 5-132 cells/mm³) and high HIV viral load. All diagnoses were confirmed by biopsy results. Along with the highly active antiretroviral treatment, the systemic chemotherapy was used in the severe cases, while the local tumor was surgically removed. We will discuss the clinical aspects and the treatments performed in addition to emphasizing the relationship between oral lesions and the human herpesvirus-8 tropism by oral epithelial cells. AIDS associated with Kaposi sarcoma (KS-AIDS) is one of the most prevalent malignant neoplasms in people with HIV. It usually presents initially as violaceous cutaneous lesions, but oral mucosa, lymph nodes, and visceral organs may be affected, sometimes without skin involvement, being an important prognostic factor. The aim of this presentation is to report 4 KS-AIDS cases with oral involvement. All cases occurred in black or mixed-race men, aged between 23 and 31, showing extremely low CD4 counts (range, 5-132 cells/mm³) and high HIV viral load. All diagnoses were confirmed by biopsy results. Along with the highly active antiretroviral treatment, the systemic chemotherapy was used in the severe cases, while the local tumor was surgically removed. We will discuss the clinical aspects and the treatments performed in addition to emphasizing the relationship between oral lesions and the human herpesvirus-8 tropism by oral epithelial cells.

Schistosomiasis was not associated with higher HIV-1 plasma or genital set point viral loads among HIV seroconverters from four cohort studies.

BackgroundMany regions of sub-Saharan Africa experience a high prevalence of both schistosomiasis and HIV-1, leading to frequent coinfection. Higher plasma HIV-1 viral loads are associated with faster disease progression and genital HIV-1 loads are a primary determinant of HIV-1 transmission risk. We hypothesized that schistosome infection would be associated with higher HIV-1 viral loads in plasma and genital samples.Methods/Principal findingsWe utilized data from individuals who HIV-1 seroconverted while enrolled in one of four prospective cohort studies. Plasma and genital viral loads collected 4–24 months after the estimated date of HIV-1 acquisition, but prior to antiretroviral therapy initiation, were included. Detection of circulating anodic antigen in archived blood samples, collected prior to HIV-1 seroconversion, identified participants with active schistosomiasis; immunoblots determined the schistosome species causing infection. Our analysis included 370 HIV-1 seroconverters with plasma viral load results, of whom 82 (22%) had schistosomiasis. We did not find a statistically significant association between schistosomiasis and higher HIV-1 set point plasma viral loads (-0.17 log10 copies/ml, 95% CI -0.38 to 0.03); S. mansoni infection was associated with a lower set point (-0.34 log10 copies/ml, 95% CI -0.58 to -0.09). We found no association between schistosomiasis and cervical (+0.07 log10 copies/swab, 95% CI -0.20 to 0.34) or vaginal (+0.11 log10 copies/swab, 95% CI -0.17 to 0.39) set point viral loads; S. haematobium infection was associated with lower cervical viral loads (-0.59 log10 copies/swab, 95% CI -1.11 to -0.06).Conclusions/SignificanceThese results do not support the hypotheses that schistosome coinfection increases plasma or genital HIV-1 viral loads.

Stimulant Use and Study Protocol Completion: Assessing the Ability of Men Who Have Sex with Men to Collect Dried Blood Spots for Laboratory Measurement of HIV Viral Load.

Stimulant use is associated with higher HIV viral load (VL) and sexual HIV transmission risk among men who have sex with men (MSM) living with HIV. There is little research on willingness of drug users living with HIV to fully participate in studies, especially those involving self-collection of biomarker data. This study presents findings from an at-home dried blood spot collection study measuring laboratory-quantified VL among U.S. HIV-positive MSM who reported high-risk sexual behavior and/or suboptimal antiretroviral therapy (ART) adherence to assess the association between drug-use behavior and (1) ability to complete a study protocol and (2) VL outcomes. Among recruited participants (n = 766), 35% reported stimulant drug use (amphetamines, cocaine, crack, crystal meth, ecstasy, or a combination of stimulant drugs), 39% reported using other drugs (heroin, marijuana, prescription opioids, and others), and 27% reported no drug use in the past 3 months. In all, 61% of enrolled participants completed the study protocol. Stimulant drug users were less likely (ARR 0.84; 95% CI 0.72-0.98) to complete the protocol than other drug users. Furthermore, other drug users were significantly less likely than non-drug users (ARR 0.52; 95% CI 0.28-0.97) to have an HIV VL result ≥ 1500 copies/mL. This study provides important estimates regarding the likelihood of participation in biomedical research activities among HIV-positive MSM with varying drug-use behaviors, showing that it is feasible to conduct such biomedical studies with drug-using MSM who report high-risk sexual behavior and struggle with their ART adherence.

1872 Mycobacterium Avium Complex Colitis in a Patient With AIDS

INTRODUCTION: Disseminated mycobacterium avium complex (MAC) is an uncommon diagnosis with the advent of highly active anti-retroviral therapy (HAART). The International Antiviral Society-USA Panel and the US Department of Health and Human services recently changed their guidelines recommending against routine MAC prophylaxis in patients on HAART. Gastrointestinal manifestations of MAC typically result in diarrhea, fever, weight loss, and abdominal pain. The diagnosis is clinically challenging as radiographic findings are non-specific and cultures can be negative for up to 2 weeks. Upper endoscopy with biopsy is required to make the diagnosis. We present a rare case of MAC colitis in a patient with AIDS with only focal subtle endoscopic changes. CASE DESCRIPTION/METHODS: A 31-year-old male was admitted for fevers, chills, diarrhea and rectal pain for 1 week. The patient was diagnosed with HIV 1 year prior and declined HAART. On admission, the patient had a benign abdominal exam with tender inguinal lymphadenopathy. Computed tomography (CT) of the abdomen/pelvis without contrast demonstrated subtle wall thickening in the rectosigmoid consistent with proctocolitis. His absolute CD4 count was 38 cells/uL, unfortunately an HIV viral load was not checked. Stool culture with shiga toxin, clostridioides difficile, coccidioides, stool giardia/ova and parasites/cryptosporidium were negative. Cytomegalovirus (CMV) serum PCR was positive at 15,400 IU/mL. Colonoscopy showed normal mucosa throughout the colon and terminal ileum, except for a single, subtle, erosion of the rectum 2 mm in length. Biopsies taken of the solitary erosion were notable for acid fast bacilli concerning for intestinal MAC, CMV was negative. An interferon gamma release study was indeterminate. The patient was discharged on therapy for CMV viremia. DISCUSSION: The incidence of disseminated mycobacterium avium infection has decreased to 2 cases per 1000 person-years with the use of HAART. However, the risk of infection increases with high HIV viral loads &gt;1000 copies/mL, previous or concurrent opportunistic infections, and CD4 count &lt;50 cells/uL. Gastrointestinal MAC is rare, and when identified is most commonly found in the small bowel. Endoscopically, this is associated with granular, erythematous mucosa with ulcerations. Identification of the pathogen can be difficult unless direct biopsies of suspicious lesions are obtained on endoscopy.

People with high HIV viral load within risk networks: who are these people and who refers them best?

Introduction:Viral load is one of the most important determinants for HIV transmission. Identification of people with high viral load (PHVL) can be effective in limiting onward HIV transmission. In order to improve the identification of these individuals within risk networks, we determined a) the number of PHVL recruited through risk networks b) their socio-demographic, behavioural and clinical characteristics and c) the characteristics of individuals who referred these PHVL to the study.Methodology:From November 2013 to March 2016, in Odessa, Ukraine, Transmission Reduction Intervention Project (TRIP) was implemented to identify people recently infected with HIV within the risk networks of “seeds” and “venues” where they engaged in risk behaviour.Results:TRIP identified 53 PHVL, of whom 32 (60%) injected drugs; 42 (79%) were unaware of their HIV status; 25 (47%) had more than one sex partner, and only 14 (26%) were using condoms. There were 164 people who referred individuals into the study; 33 of them (20%) referred PHVL. In terms of referrers, those with lower than secondary level of education, not living with a sex partner, and reporting regular condom use were significantly more likely (p < 0.05) to refer PHVL. Most PHVL (38, 72%) and their referrers (27, 82%) were found through venues.Conclusions:In Odessa city, PHVL are at high risk of transmitting HIV as the majority inject drugs, do not know their HIV status, and have unprotected sex and/or multiple partners. Targeting these individuals for HIV prevention, harm reduction and initiation of antiretroviral treatment (ART) is urgent.

CASE OF AN HIV- POSITIVE PATIENT CO-INFECTED WITH MULTIDRUG-RESISTANT TUBERCULOSIS

Tuberculosis has a greater impact on morbidity and mortality in HIV-1-infected individuals than the rest of the opportunistic infections. We reporta case of 57-year-old HIV-infected patient co-infected with multidrug- resistant tuberculosis (MDR-TB).&#x0D; The patient`s leading clinical syndromes were fever, diarrhoea and weight loss. The meticulously performed laboratory investigations revealed severe immune suppression and high HIV viral load. Microbiological and parasitological tests confirmed the presence of two AIDS-defining conditions: disseminated candidiasis and cryptosporidiosis. Sputum smear microscopy for acid-fast bacilli was negative but sputum culture showed positive result for Mycobacterium tuberculosis. Drug susceptibility testing determined resistance to isoniazid and rifampicin (MDR-TB). The diagnosis was confirmed with Xpert-MTB/RIF PCR test. Treatment continued with second-line anti-TB drugs, together with antiretroviral therapy.&#x0D; Culture conversion was recorded in the first month. The outcome was reported as „cured“ after 16 months` therapy. This case shows yet again that the clinical manifestation of tuberculosis in HIV-infected patients is very atypical. Multidrug-resistant tuberculosis requires prolonged treatment andrepresents therapeutic challenge because of the possibility of adverse drug reactions.

Intakes of Vitamin a and Zinc and Markers of Oxidative Stress in Newly Diagnosed HIV-positive Participants in the MASH Cohort in Miami (P24-016-19)

ObjectivesHIV infection is characterized by increased oxidative stress. We examined the association of antioxidant intake with measures of oxidative stress and HIV disease progression in newly diagnosed HIV-infected participants. MethodsCross-sectional study of 52 newly-diagnosed HIV-positive participants in the MASH cohort. Blood was drawn for parameters of oxidative stress (oxidized glutathione % and oxidative mitochondrial DNA damage [8-oxo-dG]) and disease stage (CD4- cell counts; HIV-viral load). Questionnaires on demographics and 24-hour dietary recalls and Alcohol Use Disorders Identification Test (AUDIT) were administered. AUDIT scores ≥ 8 was considered hazardous drinking. Dietary intakes of vitamin A and Zinc were calculated. SPSS was used for analyses and Linear Regression Models were estimated. ResultsParticipants were 74% male, 75% Black Non-Hispanic, and 21% Hispanics. Mean age was 42.3 ± SD10.2 years, CD4 count was 506.7 ± SD733.4 cells/μLA cross-sectional and HIV viral load was 3.63 ± SD1.23log10 copies/mL. Dietary intake of vitamin A (β = −0.001, SE = 0.0002, P = 0.044) and zinc (β = −0.0004, SE = 0.0002, P = 0.044) were inversely related with mitochondrial DNA damage (8-oxo-dG), after adjusting for education, race, age, gender, and excessive alcohol use. Oxidized glutathione percentage was directly associated with HIV-viral load (β = 0.81, SE = 0.4, P = 0.037) adjusting for age, gender, AUDIT ≥ 8 and BMI in linear regressions. ConclusionsLower intake of vitamin A and Zinc were associated with higher oxidative stress and higher HIV viral load. These findings suggest that antioxidant supplementation may be beneficial immediately after receiving a diagnosis of HIV infection as well as during antiretroviral treatment. Funding SourcesFunded by the National Institute on Drug Abuse and the National Institute of Health.

Structure of human ferroportin (SLC40A1) inferred from mass spectrometry restraints

Abstract Nearly all organisms require iron for red blood cell manufacture, respiration, metabolism and immunity, and as cofactor in several enzymes. Paradoxically, free iron is toxic from the production of reactive oxygen species which induce cellular injury and damage to DNA. It is essential that iron is tightly regulated. Ferroportin is the only known exporter of cellular iron in mammals. Its function and expression are tightly regulated by hepcidin. Carriers of ferroportin mutation Q248H show reduced sensitivity to hepcidin, have elevated iron stores and high HIV-1 viral load. In HIV-1 infection, there is marked alteration in iron balance indicated by high ferritin levels. As well, iron-regulating peptide hepcidin is greatly elevated. High iron stores correlate with high morbidity, increased opportunistic infections and faster progression to AIDS: high iron content in bone marrow macrophage parallels greater infection, immune dysfunction and poor prognosis. By contrast, other studies show that patients who were being treated for iron overload with iron chelators had delayed AIDS progression and longer survival. In spite of its importance little structural information is available on human ferroportin, and how iron is transported through ferroportin is not understood. We have built the structure of ferroportin using hybrid methods with restraints from mass spectrometry. Our model comprises 12 transmembrane helices. The iron binding site matches what is seen in crystal structures of distant orthologs. We are using this structure along with functional data to answer outstanding questions about the mechanism of ferroportin, iron transport and the importance of the Q248H mutation found in African and black American populations.

Intestinal helminth infections in HIV-infected patients in Savannakhet after establishment of an HIV registration network in Lao People\u2019s Democratic Republic

BackgroundIn Lao People’s Democratic Republic (PDR), which borders China, Vietnam, Cambodia, Thailand, and Myanmar, the number of HIV-infected patients has increased in recent years. HIV-infected patients diagnosed in Lao PDR are enrolled in a registration network and receive antiretroviral therapy (ART) covered by governmental financial support. Based on the registration network, we investigated intestinal helminth infections and coinfection with HTLV-1 in HIV-infected patients treated with an early intervention using ART in Lao PDR.MethodsThis cross-sectional study of all 252 HIV-infected patients at Savannakhet Provincial Hospital, located in the southern part of Lao PDR, was conducted between February and March 2018. Socioepidemiological information and clinical information were collected from a registration network database and by questionnaire administered to participants. Microscopic examination of intestinal helminth infections in stool samples and particle agglutination for anti-HTLV-1 antibody in plasma were performed.ResultsThe median age of all 252 participants was 39 years old (range, 18–59). Based on the registration network database, there were 156 (61.9%) HIV-infected patients with a CD4-positive cell count ≥ 200 cells/μL and 146 (57.9%) with an HIV viral load < 250 copies/mL. Among 212 stool samples, 75 (35.4%) were found to contain one or more intestinal helminth species, including Opisthorchis viverrini (16.5%), Strongyloides stercoralis (10.8%), hookworm (10.4%), and Taenia saginata (3.3%). This rate of intestinal helminth infections was lower than that of a previous report conducted before the establishment of the registration network for HIV-infected patients in Lao PDR. There was no significant association between intestinal helminth infections and a lower CD4-positive T cell count or higher HIV viral load. HIV-infected patients with anti-HTLV-1 antibody positivity were not found in this cohort.ConclusionThe registration network and an early intervention using ART may provide good medical care and improve the clinical course of HIV-infected patients in Lao PDR. However, the incidence of intestinal helminth infections remains high at 35.4%. The development of a specific medical care system for helminth infection for HIV-infected patients is necessary.

Rapid emergence of cryptococcal fungemia, Mycobacterium chelonae vertebral osteomyelitis and gastro intestinal stromal tumor in a young HIV late presenter: a case report

BackgroundHighly active antiretroviral therapy has significantly changed the natural history of HIV infection, leading to a dramatic reduction of HIV-related morbidity and mortality. Late Presenters, Very Late Presenters and AIDS presenters still represent, also in Europe, including Italy, a huge challenge in terms of diagnostic and therapeutic management.Case presentationA 35-year-old male with a history of fever and back pain. HIV test resulted positive with a high HIV Viral Load and a very low T-CD4 number of cells (5 cells/mm3). Imaging investigations revealed multiple vertebral and pulmonary lesions together with abdominal and thoracic lymphadenopathy. Blood cultures were positive for Cryptococcus neoformans and for Staphylococcus haemolyticus.Lymphnode biopsy resulted positive in PCR for Non-Tuberculosis Mycobacteria (Mycobacterium chelonae). A gastric biopsy also revealed a GIST. The patient also had CMV DNA positive. Although we performed antiretroviral therapy and specific-therapies for each disease, he was transferred to intensive care unit where he died due to an Acute Respiratory Distress Syndrome.ConclusionThe reported case is unusual due to the relevant number of opportunistic diseases (both infectious and tumoral) emerging not long after the HIV infection had been diagnosed.Late presenters HIV patients and AIDS presenters still represent a challenge, which is often too complex for clinicians to deal with. In spite of proper management, the risk of suboptimal results cannot be excluded.