Highly Active Antiretroviral Therapy Group Research Articles

Changing Paradigm of Yeast Isolates in HIV-Seropositive Patients with Oropharyngeal Candidiasis (OPC).

Background Oropharyngeal candidiasis (OPC) is a common fungal infection in HIV-seropositive patients. Understanding the spectrum of yeast isolates and their antifungal susceptibility patterns is crucial for effective management. This study aimed to determine the yeast isolates, antifungal susceptibility patterns, and associated factors in HIV-seropositive patients with OPC. Material and methods A prospective observational study was conducted on 350 HIV-seropositive patients attending an Integrated Counselling and Testing Centre (ICTC) at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar. Yeast isolates from oropharyngeal lesions were identified, and their antifungal susceptibility was determined by automated method VITEK 2. Demographic characteristics, highly active antiretroviral therapy (HAART) status, and CD4+ cell count categories were analyzed for associations. Results This study of 350 HIV-seropositive patients revealed that 100 tested positive forCandida, with distinct differences between HAART (n=67) and non-HAART (n=33) groups. HAART patients had a younger age distribution and higher median CD4+ cell counts (350 vs. 250 cells/mm³, U = 175, p < 0.05) compared to non-HAART patients.Candida albicanswas the most common species in both groups, but significant variations in species distribution (χ² = 9.23, p < 0.05) and antifungal susceptibility were noted. Specifically, susceptibility differences were significant for flucytosine (χ² = 7.21, p = 0.027) and voriconazole (χ² = 8.64, p = 0.013), emphasizing the influence of HAART on managing immune function and antifungal resistance in HIV patients. Conclusion This study provides insights into the spectrum of yeast isolates and their antifungal susceptibility patterns in HIV-seropositive patients with OPC. The findings emphasize the importance of considering multiple factors, such asCandida species, HAART status, and individual patient characteristics, in treatment decisions. The results will aid in the development of evidence-based management protocols for this vulnerable population. Further research is warranted to explore additional factors influencing antifungal susceptibility and optimize treatment strategies for this patient population.

Hepatoprotective effect of methanol fruit extract of Punica granatum L in highly active antiretroviral therapy-induced toxicity in Wistar rats

Prolonged use of Highly Active Antiretroviral Therapy (HAART) has been linked to toxicity, particularly hepatotoxicity. There are few effective drugs for HAART patients that promote hepatic cell regeneration and prevent liver injury. Therefore, the purpose of this study was to investigate the hepato-protective activity of Methanol fruit extract of Punica granatum (MFEPG) in HAART-administered rats. Thirty rats weighing between 150–200 g were randomly divided into six groups and each group comprised of five rats. Distilled water was given to the rats in group one. Only HAART was given to the rats in group two. MFEPG at doses of 100 and 400 mg/kg was given to the rats in groups three and four. MFEPG dosages of 100 and 400 mg/kg along with HAART were given to the rats in groups five and six, respectively. All treatments were via oral gavage daily for 40 days. Under halothane anesthesia, all rats were sacrificed on day 41. Liver tissues were utilized for lipid peroxidation marker; Malondialdehyde (MDA), antioxidant enzymes; Superoxide dismutase (SOD) and Catalase (CAT) and histological evaluation, while blood samples were examined for biochemical parameters (AST, ALT, ALP, Total cholesterol, Total protein, and Albumin). The HAART-treated group exhibited a significantly higher amount of the lipid peroxidation end product; MDA, and significantly lower levels of antioxidant enzymes; SOD, and CAT. Liver enzymes and total cholesterol were significantly increased with a significant reduction in Total protein and Albumin levels in the HAART-treated group. Conversely, the liver function biomarkers were returned to normal levels in the HAART and MFEPG-treated groups. Histopathological studies revealed that when HAART-exposed rats were treated with MFEPG, both the biochemical and histological results significantly improved. Thus, the antioxidant activity of MFEPG provides protection against HAART-induced liver oxidative damage. More research is needed to determine the safety of using MFEPG in humans.

HAART medication and oral health status in children and adolescent HIV infected: A case control study.

The advent of Highly Active Anti-Retroviral Therapy (HAART) does influence the overall oral health care of children. The children undergoing HAART have shown an increase in caries activity owing to sugars in medicines to make them more palatable. The aim of the study was to assess and compare the Oral Health of Children Living with HIV/AIDS (CLHAs) and Adolescents Living with HIV/AIDS (ALHAs) undergoing HAART and those who are HAART-naïve. This study was carried out at different Non-Governmental Organizations (NGO's) across Kerala, India. The study group consisted of 150 HIV-infected children aged 6-18 years. They were divided into two groups. Group 1 comprised of children prior to onset of HAART and Group 2 included children who had been on HAART for more than 3 years (HAART naïve). The assessment of dental caries status and dental plaque status was done. The observations were tabulated and statistically analyzed. On Statistical Analysis, significant difference was noted between the groups with the Group 1(2.26±0.58;p value=.000*) showing higher scores of dental plaque and a significant difference was also observed with respect to dental caries scores with DMFT and dmft scores higher in Group 2(dmft 2.08±2.85; p value=.001* and DMFT 4.10±1.71;p value=.003*). It was concluded that oral hygiene conditions were poor in children with HIV, with dental plaque scores more in HAART-naïve which may be due to their lesser visits and reinforcements regarding oral hygiene from a dentist and dental caries score more in HAART group, this may be attributed to the hidden sugars present in HAART medications to make it more palatable. Early recognition and management of oral conditions are important to improve the quality of life for these children.

Changes in the Metabolic Profile of HIV Infected Subjects on Highly Active Anti-Retroviral Therapy (HAART)

The metabolic profile of HIV/AIDS patient on HAART was investigated in comparison with HIV/AIDS patient who are HAART naive and also with the zero negative controls. Sixty (60) HIV subjects were used for the study and were carefully divided into two groups of thirty (30) each; group one were those on HAART and the other HAART naive while thirty (30) zero negative subjects were used as the control. Patients used for these studies are those who have been on the treatment for at least a year and not more than three years. Metabolic parameters assessed included serum total protein, albumin, globulin, electrolytes, creatinine and lipid profile. Results obtained reveals no significant (P &gt; 0.05) changes in the serum electrolyte and creatinine concentrations in all groups and similar trend was also observed for total protein and albumin levels but a significant (P&lt; 0.05) reduction was observed in the level of serum globulin concentration of patients on HAART (2.86±0.67) compared with the HAART naive (3.41±0.62). More so, there was significant (P&lt;0.05) elevation in the serum total cholesterol concentration for the HAART group (150.9±15.01) compared with HAART naive (114.5±17.04) and similar trend was also observed for LDL-cholesterol which may be a possibly indication of altered lipid metabolism. Thus, patients on HAART should carry out routine biochemical check most especially lipid panel assessment to avoid risk of altered metabolism; lipid dystrophy etc.

Ultrasonic evaluation of carotid artery elasticity in People Living with HIV

Objective To evaluate the quantitative parameters of carotid elasticity in healthy people and People Living With HIV(PLWH) by ultrasonic vascular elasticity quantitative technique, and to explore the feasibility of this technique in non-invasive evaluation of preclinical arterial elasticity in patients with PLWH atherosclerosis. Methods Subjects with carotid intima-media thickness (IMT) &lt; 1.5mm were divided into three groups: healthy control group (n = 60), HIV baseline group (n = 291) and HAART group (n = 67) with HIV infection who had received highly active antiretroviral therapy ((HAART) for more than 5 years. Quantitative analysis of ultrasonic vascular elasticity was performed in all subjects, and the software automatically quantified carotid artery IMT, artery internal diameter, motion amplitude, vascular hardness coefficient and carotid artery pulse wave velocity,( caPWV), and thean to compare the ultrasonic parameters and blood lipids of each group. In HAART group, the correlation between brachial-ankle pulse wave velocity (baPWV) measured by traditional pressure wave method and caPWV was analyzed. Results Total Cholesterol (TC), triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) in HAART group were higher than those in baseline group (P &lt; 0.017). Hardness coefficient and caPWV of bilateral carotid arteries in HAART group were higher than those in baseline group (P &lt; 0.017), but the movement amplitude was lower than that in baseline group. In the healthy group, there was no significant difference between the left and right carotid arteries (P &gt; 0.05). In HAART group, baPWV was linearly correlated with caPWV, with the left side correlation coefficient of 0.60 and the right side correlation coefficient of 0.57. Conclusion There is a decrease in preclinical elasticity of carotid artery in patients with PLWH who take antiviral therapy for a long time, and ultrasound vascular elasticity quantitative technique is helpful to identify this change.

Antifungal drug susceptibility of fungal isolates in patients with human immunodeficiency virus receiving highly active antiretroviral therapy

<h3>Objectives</h3> Given the evolving drug therapy options and consequent opportunistic infections, antifungal drug resistance is a major concern in patients with human immunodeficiency virus (HIV) undergoing highly active antiretroviral therapy (HAART), prompting the need for clinically relevant antifungal susceptibility testing. The goals of the present study were to determine the asymptomatic oral fungal carriage and species distribution in patients with HIV infection receiving HAART in Kerala State, India, and to evaluate the antifungal susceptibility/resistance profile of these oral fungal isolates. We also sought to identify any correlation between antifungal susceptibility/resistance with respect to the duration of HAART therapy and if there was an association between oral fungal colonization, CD4 counts, and risk factors. <h3>Methods</h3> Thirty HIV-positive patients receiving HAART were divided into 2 groups based on duration of HAART (group 1, <2 years; group 2, >2 years). A detailed history, including demographic characteristics, treatment details, and presence of any risk factors for candidiasis, was taken before saliva sample collection by the oral rinse method. Candidal growth and colonies were evaluated on the Sabouraud slope. Germ tube, sugar assimilation, and fermentation tests were used for identification of species. When conventional methods failed to identify any fungal isolates, they were verified using the automated VITEK-2 YST system (bioMérieux, Marcy l'Etoile, France). The Wilcoxon signed-rank test was used to compare the CD4⁺ lymphocyte count before and after initiation of HAART. The association of risk factors with candidiasis was analyzed using the chi-square test. <h3>Results</h3> Overall culture positivity was 83.3%. <i>Candida albicans</i> was the most prevalent species (57.7%), followed by <i>Candida tropicalis</i> (26.9%). All except for 1 patient had a single fungal isolate. In vitro antifungal susceptibility testing of the isolates revealed that all candidal species were sensitive to amphotericin B. <i>Candida krusei</i> showed 100% resistance to fluconazole. All candidal species except <i>Geotrichum klebahnii</i> showed increased resistance to itraconazole. Comparison between initial and recent CD4⁺ counts revealed improvement in the CD4⁺ count after HAART, but no change in fungal population. Of the study sample, 63.3% had risk factors for candidiasis other than being immunocompromised, and colonization was increased in those with risk factors compared with those without risk factors. <h3>Conclusions</h3> The present study showed the distribution of yeast species and the antifungal drug susceptibility of fungal isolates in patients with receiving HAART.

The impact of the duration of HAART on cytokine profiles in pregnancy.

To determine the cytokine profile of HIV infected women treated with highly active anti-retroviral therapy (HAART) of variable duration in pregnancy. HIV infected women were enrolled at a large tertiary hospital in Durban, South Africa in their antenatal period and stratified into those that initiated HAART before pregnancy (pre-pregnancy HAART or PPH group) and those who initiated HAART during pregnancy (in-pregnancy HAART or IPH group). These were compared with HIV negative women (HN group), matched for gestational age at the time of enrolment. Serum was obtained and Th1 and Th2 cytokines expression determined using the Bio-Plex Pro™ Human Cytokine Treg Panels. The overall cytokine profile of the cohort was pro-inflammatory as a result of significant IL-6 and TNF alpha expression. The anti-inflammatory markers (i.e. Th2 cytokines, namely IL4 and IL10) were poorly expressed by the whole cohort, with IL 4 seen almost exclusively in the IPH group, thus counter-balancing the predominantly pro-inflammatory milieu only in this group. PPH group had a pro-inflammatory milieu comparable to the HN control. IL 6 was the predominant cytokine in all groups, and as expected, it increased with advancing gestation in all the groups. This highly pro-inflammatory milieu was unexpected and needs further review CONCLUSION: Long use of HAART suppresses the anti-inflammatory markers previously reported to be conducive for the wellbeing of pregnancy. This effect needs further review as it was similarly observed in our HIV uninfected controls.

The clinical significance of serum autoantibodies and HLA-B(27) molecule testing in Uygur patients with human immunodeficiency virus infection

Objective: To explore the clinical value of serum autoantibodies and human leukocyte antigen (HLA-B(27)) molecular testing in Uygur patients with human immunodeficiency virus (HIV) infection. Method: A total of 727 HIV-infected Uygur patients who visited Kuche infectious diseases hospital during May 2016 to March 2017 were include in this study. The other 390 healthy people were enrolled as controls. Serum antinuclear antibodies (ANA), anti-cyclic citrullinated peptide (CCP) antibody, anti-extractable nuclear antigen (ENAs) antibody and HLA-B(27) molecule were tested. Result: Among 727 HIV-infected Uygur patients, 317 were males and 410 were females with mean age (35.52±13.44) years old. The mean duration of disease was (6.34±3.05) years. There were 697 (95.87%) patients receiving highly active antiretroviral therapy (HAART) with mean duration of treatment (5.52±3.47) years. The mean CD4(+)T cell count was (520±271) cells/μl in 202 HIV-infected patients, and mean virus load was (108 139±20 498) copies/ml in 20 HIV-infected patients. Rheumatic manifestations were recorded in 238 (32.74%) HIV-infected Uygur patients, mainly with dry mouth and dry eye (15.41%) , alopecia (9.90%) , arthralgia (8.94%) , ect. Compared with the health controls, positive ANA was more common in HIV infected Uygur patients (33.43% vs. 17.43%, P<0.001) with low titers (ANA titer:1∶100) . HIV-infected Uygur patients had higher positive anti-u1-RNP antibodies positive rate (1.10%), but lower anti-SSA antibodies positive rate (0.14%) and anti-CCP antibodies positive rate (0.28%). Patients with positive ANA in HAART group were significantly less than that in non-treatment group (32.71% vs. 50.00%, P=0.049). There were no correlations between ANA and duration of HAART, CD4(+)T cell counts and virus load (r values 0.061, 0.047, 0.121, respectively. P>0.05). Only one female patient was HLA-B(27) positive (0.14%), which was significantly lower than that in healthy controls (3.08%) (P<0.001). Also, only one patient was diagnosed with rheumatoid arthritis (RA). Conclusion: Autoimmune manifestations are common in HIV-infected Uygur patients. Several autoantibodies are positive, but the coincidence of rheumatic diseases is rare. It's noted that patients with autoimmune manifestations should be considered as a differential diagnosis of HIV infection.

Association between highly active antiretroviral therapy (HAART) and hypertension in persons living with HIV/AIDS at the Bamenda regional hospital, Cameroon.

IntroductionThe introduction of highly active antiretroviral therapy (HAART) in the treatment of HIV infection has provided different good results: like long-term viral suppression, the decrease of opportunistic infections, and repair of the immune system.MethodsWe carried out a hospital-based cross-sectional analytic study involving 315 participants 228 were on HAART (group 1) and 87 were HAART-naïve (group 2) at the HIV treatment centre of the Bamenda regional hospital with our study population being all people living with HIV (PLWHIV) in the North West region of Cameroon. The sampling was performed from the 15th of March to the 30th of June 2017. The questionnaire was administered face to face with participants and their vital signs taken. Blood pressure was measured using an automated electronic blood pressure monitor and hypertension (HTN) was considered as systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic BP ≥ 90mmHg.ResultsThe prevalence of hypertension in the HAART group was 36.44% (n=82, CI: 30.15%-43.10%) compared to that of the HAART-naïve group which was 13.33% (n=12, CI: 7.08%-22.13%, P=0.01). HAART was associated with HTN after controlling for gender, family history of hypertension, body mass index (BMI), smoking and alcohol consumption. The odds ratio of the HAART-treated versus the HAART-naïve was 3.86 (95% CI: 1.98-7.50). We also found an association between TDF/3TC/EFV (OR=2.83), AZT/3TC/NVP (OR=2.82), AZT/3TC+EFV (OR=3.48) and TDF/3TC+NVP (OR=2.36) and HTN whereas those on AZT+3TC+ATV/r (OR=0.84) and TDF+3TC+ATV/r (OR=0.45) were not associated to hypertension.ConclusionOur result suggests that blood pressure should be periodically measured and treated when necessary in PLWHIV on HAART.

Oral manifestations, salivary flow rates and Candida species in Thai HIV-infected patients.

BackgroundEffects of various Highly Active Antiretroviral Therapy (HAART) regimens on oral heath are unclear. Objectives: We aimed to evaluate effects of HAART on oral manifestations, salivary flow rates (SFR) and Candida species in HIV-infected patients who took mostly non-protease inhibitor-based HAART regimens.Material and MethodsA cross-sectional study was performed on HIV-infected patients taking and never taken HAART who attended Thai Red Cross AIDS Research Centre (n = 48). Non-HIV subjects were recruited as control (n = 20). Oral conditions and salivary flow rates were evaluated using oral examination and measurement of unstimulated and stimulated saliva. In addition, Candida colonization counts (colony forming units; CFUs) and Candida species from the collected saliva were evaluated using CHROMagar.ResultsThe most common oral manifestation in HIV-infected subjects taking HAART was hyperpigmentation. Unstimulated and stimulated SFR among the three groups were not statistically significant. Candida colonization was detected in 64%, 65% and 35% of HIV-infected subjects taking HAART, HAART-naïve, and non-HIV subjects, respectively. While 20% and 35% of HIV-infected subjects with and without HAART, respectively, had Candida CFUs higher than 500/ml, all non-HIV carriers had Candida CFUs lower than 500/ml. The most common Candida colonization species was C. albicans in HAART and non-HIV groups. Interestingly, HAART-naïve group was colonized more by non-albicans species.ConclusionsHAART has minimal effects on oral health. While HAART may not prevent Candida colonization, it might lead to reduction of non-albicans species. Because maintaining low Candida counts is important, HAART administration and antifungal sensitivity test should be considered in HIV-infected patients. Key words:HIV, Candida, HAART, Oral manifestation, Salivary flow rates.

Histo-morphological and seminal evaluation of testicular parameters in diabetic rats under antiretroviral therapy: interactions with Hypoxis hemerocallidea.

Objective(s):Broad range of metabolic changes associated with highly active antiretroviral therapy (HAART) has been reported over decades including reproductive perturbations. The current study aimed at investigating the role of Hypoxis hemerocallidea (Hyp) in the seminal and morphometric alterations in the testes of streptozotocin-nicotinamide-induced diabetic rats under HAART.Materials and Methods:Sixty-two adult male Sprague-Dawley rats were divided into A-H groups, containing 6 rats in the control group A and 8 rats in the treatment groups B-H. Diabetes was induced by intraperitoneal injection of nicotinamide (110 mg/kg BW) followed by streptozotocin (45 mg/kg BW). The animals were then subjected to various treatments with HAART, Hyp, and melatonin.Results:weights (body and testicular), histological, histochemical, seminal fluid, and morphometric analyses were carried out. Sperm count and motility were reduced in HAART (P<0.05/0.003) and Hyp200 (P<.003) groups compared with normal and diabetic controls, respectively. Sperm count was higher (P<.003) in HAART+ Mel and HAART+Hyp100 groups. Morphometry showed the reduction in germinal epithelium height and basement membrane thickness (P<.003) in the Hyp100 group compared with diabetic controls. Adjuvant use of Hyp and melatonin with HAART did not significantly raise these indices (P>.05). Histological slides showed gross distortions in HAART, diabetic and HAART +Hyp groups with marked atrophy in tubules, germ cell loss and areas of focal depletion of the cell. PAS staining revealed detached basement membrane in diabetic groups with strong PAS-stain. Conclusion:The use of Hyp or melatonin does not ameliorate the testicular damages in diabetic animals under antiretroviral therapy.

The Use of First Line Highly Active Anti-Retroviral Therapy (HAART) is Not Associated with Qtc Prolongation in HIV Patients.

HAART has improved survival of HIV patients. Its contribution to the development of new cardiovascular abnormalities has generated much interest. This study aimed at determining the prevalence of QTc prolongation among HIV patients and determining the influence if any of the use of HAART on the QTc and on the risk of having QTc prolongation. One hundred and fifty HIV positive subjects comprising 76 HIV positive subjects on HAART (Group A), 74 who were HAART- naïve (Group B), and 150 age and sex-matched healthy controls (Group C) were studied. All subjects had electrocardiography, and QTc duration was calculated. Mean QTc was significantly different among the three groups (P <0.001), highest in Group B > Group A > Group C. Frequency of QTc prolongation was highest in Group B (32%)>, Group A (17.3%)> Group C (4.7%) (P<0.001). Mean QTc was significantly longer among patients with CD4 count <200 cells/mm3 than among those with >200 cells/mm3 0.445 ± 0.03secs vs 0.421 ± 0.03secs (P<0.001). QTc prolongation was commoner among individuals with CD4 count <200 cells/mm3 50% vs 20.5% (P<0.001). On binary logistic regression, none of the HAART medications used by our patients was predictive of the occurrence of QTc prolongation. The QTc is longer, and QTc prolongation occurs more frequently in HAART-naïve HIV patients than patients on HAART and healthy controls. None of the HAART medications used by our patients was predictive of the development of QTc prolongation.

The effects of setarud on the immunological status of HIV-positive patients: Efficacy of a novel multi-herbal drug.

This study examines the effect of the addition of IMOD, a novel multi-herbal drug to the highly active anti-retroviral therapy (HAART) regimen, on the immunological status of HIV-positive patients. A randomized two-parallel-group (HAART group versus HAART+IMOD group), pretest-posttest design was used.Sixty patients with indications for treatment with the HAART regimen participated. One week before and 2 days after the treatments, immunological parameters including total lymphocyte count (TLC) and CD4 cell count were assessed.The intervention group received the HAART regimen plus IMOD every day for 3 months. The control group received only the HAART regimen every day for 3 months. In the intervention group, a significant difference was observed in CD4between before and after drug therapy (CD4 was increased). However, in the control group, the difference in CD4 was not significant before and after drug therapy. The difference in TLC was not significantly different between the two groups before and after therapy. Nevertheless, TLC was higher in the intervention group. IMOD (as a herbal drug) has been successfully added to the HAART regimen to improve the immunological status of HIV-positive patients.

Effect of Folic Acid on Duovir-N Induced Weight, Behavioural and Cyto-Cerebellar Changes in Adult Male Wistar Rats

Duovir-N is a highly active antiretroviral therapy (HAART), a combination of three drugs (lamivudine, zidovudine and nevirapine) used for pre-exposure prophylaxis and management of human immunodeficiency virus infection in sub-Saharan Africa. This research investigated the potential ameliorative effect of folic acid on Duovir-N induced toxicity on the cerebellum. Forty adult male Wistar rats were divided into 4 groups of 10 rats each. They were administered with distilled water, 9.28 mg/kg of Duovir-N only, 9.28 mg/kg of Duovir-N and 0.07 mg/kg of folic acid, and 0.07 mg/kg folic acid. Drugs were administered twice daily for 30 days after which neurobehavioral test in the open field maze was perform. The rats were then sacrificed and their cerebellum harvested, processed and stained using haematoxylin and eosin method. Result showed a significant (p&lt;0.05) decreased in weight of the Dourvir-N (HAART) groups compared to the control or folic acid groups. There was also a significant (p&lt;0.05) reduction in the brain to body weight index between the HAART group compared with control and folic acid groups. There were no significant changes in all the parameters of the open field maze between the HAART group and the control. The cerebellum was affected with mild to moderate shrinkage of pyramidal cells and distortion of the granular cells. These results indicate that Duovir-N affects cerebella histology, and folic acid is able to ameliorate this, thus, may be beneficial to people taking Dourvir-N.

Thirty-year Perspective of the Long-term Survival, CD4 Percentage and Social Achievements of Perinatally HIV-infected Children as a Function of Their Birth Era.

Pediatric HIV has evolved from a pre-antiretroviral (ART) era (pre-1989 or pre-ART) to an ART era (1989 to 1996) and to a highly active antiretroviral therapy (HAART) era (post-1996). As we have passed the third decade following these individuals, we thought it useful to review clinical, laboratory and social outcomes. A retrospective, cross-sectional study of 399 children infected perinatally. They were divided into pre-ART, ART and HAART groups. A Kaplan-Meier plot was constructed. One hundred seventy-nine have been lost to follow-up at an average of 7.6 (0.3-27.6) years. Approximately 40%, 80% and 90% of individuals in the pre-ART, ART and HAART groups have long-term survival. One hundred twenty-one died at an average of 5.1 (0-26.1) years. Pre-ART, ART and HAART groups had mean most recent CD4% values (±SEM) of 16.74 (1.09), 22.97 (0.96) and 33.07 (2.09), respectively (P < 0.001). Pre-ART RNA is limited in that era and present if they survived to another era. In this group, the median RNA values in those who died (311,300, n = 16) was greater than in survivors (19,402, n = 45). Forty-three percent of the individuals in the ART group and 77% of individuals in the HAART group had most recent HIV RNA <400 copies/mL. Eighteen individuals >18 years of age have only a grade school or no education. Fifty-five have graduated high school or received an equivalency diploma. Twenty-three more have completed college. Nadir and recent CD4% of those who did and did not complete high school was equivalent to college graduates. Sixteen survivors (1/2 male) have had 18 uninfected children. This first long-term follow-up study demonstrates remarkable survival and social skills of our patients.

Severe dyslipidemia and immune activation in HIV patients with dysglycemia

Background and Objective: Diabetes mellitus (DM) is common in human immunodeficiency virus (HIV)-infected patients. However, the relationship between dysglycemia, lipid metabolism, and immune activation in HIV patients is poorly understood.Methods: We retrospectively analyzed the clinical data of 180 HIV patients, including 153 patients undergoing highly active antiretroviral therapy (HAART) and 27 HAART-naive patients. DM was defined as fasting serum glucose levels ≥126 mg/dl, and impaired fasting glucose (IFG) was defined as serum glucose levels of 101–125 mg/dl at two different time points. Lipid metabolic indexes were measured. CD4+, CD8+, and CD8+ HLA-DR+ T cells were determined by flow cytometry.Results: IFM and DM percentages were higher in the HAART group than in the HAART-naive group (59.5% vs. 48.1% and 21.6% vs. 7.4%, respectively; p < 0.01). Additionally, DM percentage was high in patients receiving HAART containing protease inhibitors. Serum levels of triglycerides and very low-density lipoprotein cholesterol were higher in IFG and DM HAART patients than in euglycemic HAART patients (p < 0.05). Serum triglyceride levels were higher in HAART-naive DM patients than in other patients (p < 0.05). CD8+ and CD8+ HLA-DR+ cell counts were higher in IFG and DM HAART patients than in euglycemic HAART patients (p < 0.05). Ordinal logistic regression analysis suggested that TRIG, VLDL, CD8, and HAART were predictors of glucose metabolic disorders.Conclusion: HIV patients with hyperglycemia have severe dyslipidemia and immune activation, and HAART is an important impact factor of glucose and lipid metabolic disorders.

Integrating Cervical Cancer Screening with HIV Care in Cameroon: Comparative Risk Analysis of Cervical Disease in HIV-Infected Women Receiving Antiretroviral Therapy to Women in the General Population

BackgroundWhile the effect of highly active antiretroviral therapy (HAART) on natural history of cervical lesions remains controversial, resource limited countries need to understand the relevance of their own data to their settings. We compared the risk of cervical disease in HAART-experienced women with that in women in the general population of Cameroon.MethodsA retrospective cross sectional survey of women aged 35 years and above, attending a voluntary screening campaign for cervical cancer at the Nkongsamba Regional Hospital in Cameroon between February and May 2014. Squamous intraepithelial lesions (SIL) were determined by Pap smear. Multiple logistic regression was used to compare the odds of SIL in women on HAART to women from the community with unknown HIV status.ResultsIncluded were 302 women of whom 131(43.4%) were HIV-infected and receiving HAART on the site while 171 (56.6%) were women from the community. Cervical disease was observed in 51(16.9%) persons of whom 15 (11.5%) cases in the HAART group and 36 (21.1%) cases in the general group (p = 0.027). After controlling for age and other covariates, women in the HAART group had a 67% reduction in the odds of cervical lesions compared with the community group [adjusted odd ratio (aOR) = 0.33, 95%CI: 0.15–0.73, p = 0.006).ConclusionHIV-infected women receiving HAART have a lower risk of cancer than women in the general population. This finding may not be attributed to HAART alone but to all the health benefits derived from receiving a comprehensive HIV care.

Prevalence of Hypertension in HIV/AIDS Patients on Highly Active Antiretroviral Therapy (HAART) Compared with HAART-Naïve Patients at the Limbe Regional Hospital, Cameroon

BackgroundHighly active antiretroviral therapy (HAART) has greatly reduced the morbidity and mortality of HIV/AIDS patients but has also been associated with increased metabolic complications and cardiovascular diseases. Data on the association between HAART and hypertension (HTN) in Africa are scarce.ObjectivesPrimarily to compare the prevalence of HTN in HIV/AIDS patients on HAART and HAART-naïve patients in Limbe, Cameroon; and secondarily to assess other socio-demographic and clinical factors associated with HTN in this population.MethodsA cross-sectional study was conducted at the Limbe Regional Hospital HIV treatment center between April and June 2013, involving 200 HIV/AIDS patients (100 on first-line HAART regimens for at least 12 months matched by age and sex to 100 HAART-naïve patients). HTN was defined as a systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg.ResultsThe prevalence of HTN in patients on HAART was twice (38%; 95% CI: 28.5–48.3) that of the HAART-naïve patients (19%; 95% CI, 11.8–28.1), p = 0.003. In multivariate analyses adjusted for age, gender, smoking, family history of HTN, and BMI-defined overweight, HAART was associated with HTN, the adjusted odds ratio of the HAART-treated versus HAART-naïve group was 2.20 (95% CI: 1.07–4.52), p = 0.032. HTN was associated with older age and male gender, in the HAART group and with BMI-defined overweight in the HAART-naïve group.ConclusionThe prevalence of hypertension in HIV/AIDS patients in Limbe stands out to be elevated, higher in patients on HAART compared to those not on treatment. Blood pressure and cardiovascular risk factors should be routinely monitored. Other factors such as diet, weight control and physical exercise should also be considered.

Prevalence and Influencing Factors of Thyroid Dysfunction in HIV-Infected Patients.

Thyroid dysfunction is more common in human immunodeficiency virus (HIV) patients. But the effects of highly active antiretroviral therapy (HAART) and hepatitis B/C virus (HBV/HCV) coinfection on thyroid function is unclear. We retrospectively reviewed the data of 178 HIV patients and determined the prevalence of thyroid dysfunction and the relationship between thyroid hormone levels, CD4 cell count, HIV-1 duration, HAART duration/regimens, and HBV/HCV coinfection. Of the 178 patients, 59 (33.1%) had thyroid dysfunction, mostly hypothyroidism. Thyroid dysfunction was significantly more frequent in the HAART group (41/104, 39.4%) than in the HAART-naïve group (18/74, 24.3%; P < 0.05). The mean CD4 cell count was significantly lower in patients with hypothyroidism (372 ± 331/μL) than in the other patients (P < 0.05). The FT4 level was significantly lower in the HAART group than in the HAART-naïve group (1.09 ± 0.23 versus 1.20 ± 0.29 pg/mL, P < 0.05). FT3/FT4 levels were negatively related to HIV duration and FT3 levels were positively related to CD4 cell (P < 0.05). HBV patients had lower FT3 levels, while HCV patients had higher FT3 and FT4 levels (P < 0.05). Thyroid dysfunction is more common in HIV patients on HAART, mainly manifested as hypothyroidism. FT3/FT4 levels are correlated with HIV progression. HBV/HCV coinfection increases the probability of thyroid dysfunction.

Cluster of differentiation and renal assessment of reactive HIV subjects in Akure Nigeria

Background: HIV/AIDS is a rapidly growing epidemic in sub-Saharan Africa, Nigeria in particular. The report of the 2012 National Reproductive Health Survey Plus indicated that the prevalence of HIV/AIDS in Nigeria, that is, Nigerians currently living with HIV/AIDS is about 3.4% while Ondo State has a prevalence of 4.3%. HIV is a retrovirus that primarily infects components of the human immune system such as CD4 T-cells, macrophages and dendritic cells. Objectives: To evaluate the CD4+ T cell count, sodium, potassium, urea and creatinine in adult HIV seropositive subjects on Highly Active Antiretroviral Therapy (HAART) and those yet to be started on HAART as well as HIV seronegative control subjects. Materials and Methods: Serum levels of CD4+ count of adult HIV seropositive subjects on HAART, yet to start HAART and seronegative controls were determined using flow cytometry while their serum sodium, potassium, urea and creatinine were determined using enzymatic spectrophotometric method. All data were expressed as Mean ± Standard Deviation (SD) and analysed with Analysis of Variance (ANOVA) while multiple comparisons were done using Post Hoc test. Results: The serum sodium is significantly lower in the subjects in HAART group as compared with that of the other two groups. No significant difference in urea & creatinine was found in the three groups. Conclusion: Despite the fact that it appears the drugs did not have adverse effect on the kidneys, there is need for close monitoring of patients on antiretroviral medications as various drugs over time have adverse effects on various organs.