Highly Active Antiretroviral Therapy Therapy Research Articles

Prevalence of Adverse Drug Reactions in HIV/AIDS Patients on Highly Active Anti-Retroviral Therapy in Bushenyi Medical Centre, Ishaka Adventist Hospital, and Kampala International University Teaching Hospital in Bushenyi District, Western Uganda

The World Health Organization (WHO) delineates an Adverse Drug Reaction (ADR) as an unintended and harmful response to a drug when it is used for disease prevention, diagnosis, treatment, or physiological function modification in humans. This definition specifically excludes therapeutic failures, overdose, drug abuse, noncompliance, and medication errors. The objective of this study is to determine the prevalence of ADRs among HIV/AIDS patients undergoing Highly Active Antiretroviral Therapy (HAART) at Bushenyi Medical Centre, Ishaka-Adventist Hospital, and KIU Teaching Hospital in the Bushenyi district, western Uganda. Patient interviews were conducted using structured questionnaires. A cohort of 333 patients participated in the study. The investigation revealed a prevalence of ADRs at 13.5% (95% CI: 10.2-17.6). Among the 333 patients interviewed, 44 reported experiencing ADRs, with a significant 97.8% of these cases occurring in female patients. Importantly, individuals with co-morbidities had a 55.6-fold higher likelihood of developing ADRs compared to those without any co-morbid conditions (95% CI: 2.4-1286.7). Furthermore, the study indicated an increased risk of ADR development among patients starting HAART within the first year of treatment. In summary, our findings highlight the notable prevalence of ADRs among females, emphasizing the need for gender-specific initiatives to raise awareness and prevent ADRs. Regular monitoring is particularly important for patients with co-morbidities due to the established association between co-medication and susceptibility to ADRs. Additionally, adherence to HAART therapy is essential, as the incidence of ADRs tends to decrease over time. Keywords: Adverse drug reaction (ADR), HIV/AIDS, Co-morbidities, Anti-Retroviral Therapy, Uganda

Photodynamic Therapy Used to Treat an HIV Patient with an Efflorescence of Viral Warts after HAART Therapy

Healing from viral warts lesions can be hard to achieve in immunocompromised subjects like HIV-positive patients. The therapeutic target in immunocompetent subjects can be reached using different methods, including topical ointments, cryotherapy, laser therapy, imiquimod, and photodynamic therapy (PDT). We present a case of a male HIV-positive patient who came to the Dermatology department with multifocal wart lesions on his face, auricular, and retro-auricular areas after treatment with highly active antiretroviral therapy (HAART). In our case, surprisingly, only one session of PDT proved to induce complete regression of lesions which, despite their thickness, had a much more robust response to treatment than we could have possibly expected. After a brief review of the literature, it is possible to state that PDT revealed itself to be a valid option in immunocompromised patients who have a major risk of relapse.

Effect of Highly Active Antiretroviral Therapy on Fundus Images and Retinal Microvessel Diameter in HIV/AIDS Patients

We aimed to investigate whether there were changes in fundus picture and retinal microvascularity of patients with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) who were treated with highly active antiretroviral therapy (HAART). From July 2015 to November 2016, 130 HIV/AIDS patients were collected by the Yunnan Institute of Traditional Chinese Medicine, including 63 treatment-naïve patients and 67 that received HAART for 12 months. Fundus picture lesions, retinal microvascular diameters, CD4+ T lymphocyte count and HIV-1 plasma viral loads were compared between the two groups. The recruited patients were mainly young and middle-aged, with more males than females. There were no significant differences in smoking history, comorbidities and opportunistic infections between the two groups. According to the analysis results from SPSS 20.0 software, the number of CD4+ T lymphocytes in the treated patients (563.34±2.56 cells/μL) increased significantly (P=0.009) as compared with untreated patients (451.37±2.10 cells/μL), and the HIV-1 plasma viral load reduced considerably (4794 vs 0 copy/mL, P=0.000). No significant differences were observed from the fundus picture of patients after effective HAART therapy, including the retinal artery diameter, venous diameter and arteriovenous diameter ratio.

S3585 Don’t Forget the Gut: A Case of Gastrointestinal Kaposi Sarcoma

Introduction: Kaposi sarcoma (KS) is a low grade vascular tumor associated with Human Herpesvirus-8 (HHV8) infection. The disease course is indolent with manifestations ranging from cutaneous to fulminant, visceral involvement. In the United States, KS is most often seen in those with AIDS and with increased access to highly active antiretroviral therapy (HAART) the incidence has been decreasing. GI tract involvement of KS is uncommon and few have GI symptoms; therefore, gastrointestinal Kaposi sarcoma (GI-KS) remains under-diagnosed. This case describes a patient with cutaneous involvement of KS found to have GI-KS with no GI symptoms. Case Description/Methods: A 49-year-old African American male presented with shortness of breath, non-productive cough and a 60-lb unintentional weight loss over the past year. He was diagnosed with HIV in 1999 and has been intermittently compliant with HAART therapy. In the past two years, he was started on Bictegravir/emtricitabine/tenofovir alafenamide but was non-compliant. He recently noticed the development of bilateral non-painful and non-pruritic lower skin lesions (Figure a). His CD4 count was low at 88 cells/mm3 with an elevated HIV viral load. His lower extremity skin lesion biopsy showed irregular blood vessels lined by atypical endothelial cells with an infiltrating growth pattern consistent with KS. CT chest demonstrated multiple ground glass opacities and bronchoscopy with FNA were negative for any malignancy. CT abdomen/pelvis was unremarkable. EGD and colonoscopy was done to to rule out systemic involvement which demonstrated scattered moderate mucosal changes characterized by erythema, granular nodularity in the gastric body and nodular mucosa in the rectum (Figure b/c). Biopsies demonstrated spindle cell proliferation involving the lamina propria consistent with KS. Discussion: Kaposi sarcoma is an AIDS-defining rare vascular tumor. Current recommendations for endoscopy are reserved for patients suspicious for GI involvement. This patient had poorly controlled HIV with no GI symptoms and was found to have GI-KS during endoscopy. Management of KS differs based on cutaneous versus systemic involvement. HAART therapy is the first line in management of cutaneous KS while HAART therapy and chemotherapy is first line in management for systemic KS. Therefore, undiagnosed GI-KS in patients with cutaneous KS negatively affects morbidity and mortality. Therefore, clinicians should maintain a high suspicion for GI-KS in those with AIDS and/or cutaneous KS.Figure 1.: a. Lower extremity cutaneous lesions Figure b. Gastric lesions Figure c. Rectal lesions.

Analysis of the Influencing Factors of Immunological Nonresponders in Wuhan, China.

Objective CD4+ cell recovery is hampered in some human immunodeficiency virus (HIV)-infected patients, despite a successful highly active antiretroviral therapy (HAART) with suppressed viral replication. We investigated the factors that might have hindered the CD4+ cell recovery in these patients. Methods In this retrospective study, we collected the data of all immune nonresponders (INRs) in Wuhan, China, until the end of 2020. A linear model was constructed based on the data from 220 patients with baseline and follow-up records. The response variables in this study were the CD4+ cell count increase. The predictor variables considered in this study were those factors likely to affect the CD4+ cell recovery. Results Our findings revealed that the plasma HIV-1 viral load of all patients was suppressed and 87.3% patients' CD4+ cells was increased after more than one year of the HAART treatment. In addition, their last follow-up showed a significant reduction in complications. In our results, the body mass index (BMI), number of months since HIV diagnosis to HAART start, and nonuse of co-trimoxazole were negatively correlated with the increase in CD4+ cells (P < 0.05). However, there were positive associations between serum creatinine levels and CD4+ cell recovery (P < 0.05). Further stratified analyses indicated that the associations between HAART replacement or creatinine usage and CD4+ cell growth were only observed in those participants with a BMI <18.5 (P < 0.05). Conclusions An early initiation of HAART and co-trimoxazole preventive therapy (CPT) can promote immune reconstitution. BMI and serum creatinine can serve as monitoring indicators of immune reconstitution prognosis after the HAART.

Case report: Safety and efficacy of adalimumab in treating difficult-to-treat rheumatoid arthritis in a human immunodeficiency virus-positive patient, one year follow-up

Rheumatoid arthritis (RA) is a joint-disabling inflammatory disease associated with the pathology of synovitis. Some patients with RA are difficult to treat, using disease-modifying anti-rheumatic drugs (DMARDs). Biology and targeted synthetic DMARDs (b/tsDMARDs) are options for patients with RA. Acquired immunodeficiency syndrome (AIDS) is an infectious disease caused by the human immunodeficiency virus (HIV). Adalimumab is an anti-tumor necrosis factor therapy commonly used in patients with RA. However, there are no reports or related data on patients with RA-HIV/AIDS treated with adalimumab are available. In this report, we described the first successful case of a 60-year-old HIV-positive woman with difficult-to-treat RA treated with ADA after being screened for hepatitis virus, latent tuberculosis (LTBI), and other infections. She contracted HIV from sexual exposure while on adalimumab therapy. As the patient was resistant to first-line DMARDs, she continued adalimumab along with the initiation of highly active antiretroviral therapy (HAART). The patient was treated with adalimumab therapy for a year; her CD4+ lymphocyte count was normal, HIV-1 RNA decreased, and no new infections were triggered. The patient achieved clinical remission of RA. In conclusion, adalimumab is a safe option for patients with RA-HIV and may slow the progression of HIV infection. Furthermore, HAART has the potential to reduce joint pain and fatigue in patients with difficult-to-treat RA.ConclusionsAdalimumab is a safe option for patients with RA-HIV, and may slow down the progression of HIV infection. The HAART therapy has the potential to reduce joint pain and fatigue in patients with difficult-to-treat RA.

Cutaneous Manifestations of HIV/AIDS in the Era of Highly Active Antiretroviral Therapy: Evidence from Bangladesh

Abstract Objective: Skin diseases are common and striking features of patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and may vary considerably by ethnic and geographic regions and by the influence of highly active antiretroviral therapy (HAART). However, little information exists regarding the cutaneous manifestations of patients with HIV/AIDS in Bangladesh. This study was performed to elucidate the spectrum of cutaneous disorders in patients with HIV/AIDS in the era of HAART. Materials: This descriptive cross-sectional study was carried out in Chittagong Medical College Hospital, Bangladesh from January 2017 and December 2020. Diagnosed case of HIV/AIDS for HAART therapy and all cases of HIV/AIDS who are already on HAART therapy were included in this study. Descriptive statistical analysis was carried out by using frequencies and percentages. Results: Of 40 patients with HIV/AIDS, 22 (55.0%) were male and 18 (45.0%) were female. The patients ranged in age from 8 to 60years, with a mean age of 38 ± 0.966years. Among all age groups, the highest 19 (47.5%) patients were in the 31- to 40-year age group. Most of the patients were migrant workers [22/40 (55.0%)] with low socioeconomic status [32/40 (80.0%)], and the most common transmission mode was heterosexual activity [36/40 (90.0%)]. Most of the patients [32/40 (80.0%)] had mucocutaneous disorders, 30/40 (75.0%) had infective dermatoses, and 21/40 (52.5%) had non-infective inflammatory dermatoses. Eight of forty (20.0%) patients presented with three or more skin disorders. The most common infective dermatoses were fungal infections [15/40 (37.5%)], followed by viral infections [8/40 (20.0%)], bacterial infections [4/40 (10.0%)], and scabies [3/40 (7.5%)]. The most common noninfective dermatosis was generalized pruritus [6/40 (15.0%)], followed by prurigo simplex [4/40 (10.0%)], psoriasis [4/40 (10.0%)], eczema [3/40 (7.5%)], pruritic papular eruption [1/40 (2.5%)], seborrheic dermatitis [1/40 (2.5%)], urticaria [1/40 (2.5%)], and xerosis [1/40 (2.5%)]. Patients treated with HAART had decreased rates of oral candidiasis and herpes simplex but increased rates of drug reactions [19/40 (47.5%)]. The most common drug eruption following HAART was a morbilliform rash [11/40 (27.5%)], and the most common offending agent was nevirapine. The prevalence of mucocutaneous disorders was higher in patients with a CD4 cell count of &lt;200cells/mm3. Conclusions: A wide range of mucocutaneous disorders is observed in Bangladeshi patients with HIV/AIDS, and HAART has an impact on the spectrum of HIV/AIDS-associated mucocutaneous disorders. Skin and mucocutaneous disorders are seen at every stage of HIV/AIDS and are the initial presentation in most patients in Bangladesh. There is a need for increased attention to the diagnosis and treatment of skin diseases affecting the quality of life of patients with HIV/AIDS.

Identification &amp; correlation of candida strains with CD4+ count among HIV patients on HAART and evaluation of in-vitro susceptibility to fluconazole and voriconazole

Background: HIV is a life-threatening disease that increases morbidity and mortality due to the alterations of the body's immune system, leading to several opportunistic infections due to the progressive loss of CD4+ T lymphocytes. Aim: To identify and correlate the Candida strains with CD4+ count in Human Immunodeficiency Virus (HIV) patients on Highly active antiretroviral therapy (HAART) and evaluate the in-vitro susceptibility to fluconazole and voriconazole. Materials and Methods: A total of 100 HIV-positive patients who were not under HAART therapy were examined at three different intervals for the presence of Candida strains along with their CD4+ count and evaluated for in-vitro susceptibility to fluconazole and voriconazole. The obtained values were analyzed using the Spearman correlation test and Chi-square tests with a significant P value of 0.005 and SPSS version 20.0 software. Results: C. albicans was the most common species isolated, followed by C. krusei, C. glabrata, and C. tropicalis. C. glabrata showed a positive correlation with CD4+ count at 6 months of HAART therapy. The variation in CD4+ count prior to HAART therapy and at 3 and 6 months of HAART therapy showed a significant increase in the CD4+ count. Antifungal susceptibility testing showed that all Candida strains were resistant to fluconazole and susceptible to voriconazole. Conclusion: The correlation of CD4+ count with Candida strains and in-vitro susceptibility of voriconazole to all the identified strains of Candida as observations from the present study suggests the need for more periodic studies among different sample populations with larger sample size.

Clinico-Epidemiologic Attributes of 515 Persons Living With Human Immunodeficiency Virus Infection/Acquired Immunodeficiency Syndrome on Antiretroviral Therapy: A Cross-Sectional Study from a Tertiary Care Centre of North India.

Objectives:To study the clinico-epidemiologic attributes of persons living with HIV/AIDS on highly active antiretroviral therapy (HAART).Methods:Clinico-epidemiological details, CD4 counts, previous illness and mucocutaneous diseases were studied in 515 persons living with HIV/AIDS on HAART.Results:The study comprised 250 (48.5%) males and 265 (51.5%) females aged between 10 and 79 (mean 38.9) years. The 196 (38%) males were drivers, staying-alone laborers/self-employed, and 253 (49.1%) females were homemakers. All were on HAART for one month to 9 years. Heterosexual transmission was noted in 478 (92.8%) individuals. The 274 (53.5%) individuals had 200–350 CD4 cells/mm3 counts, whereas it was <200 cells/mm3 in 88 (17.2%) individuals. Candidiasis (in 48), dermatophytoses (n = 23), herpes labialis (n = 13), herpes zoster (n = 12), seborrheic dermatitis (n = 29), generalized pruritus (n = 22), and xerosis in 20 individuals were the most common dermatoses. Most dermatoses occurred with 200–350 CD4 cells/mm3. Adverse drug reactions from antiretroviral therapy (ART) and concurrent therapies also occurred.Conclusions:Although most of our patients had mild HIV-associated dermatoses while on HAART, adverse drug reactions from HAART or concurrent therapies themselves remain a potential risk. Nevertheless, knowledge of these aspects will help planning for comprehensive health care envisaged in the National AIDS Control Program phase IV.

Effect of antiretroviral therapy on lipid profile in newly diagnosed HIV-infected children of immune stage III and IV

Background: There are increasing concerns about the adverse effects of highly active antiretroviral therapy (HAART) on lipid profiles. Limited studies reported the adverse effects of HAART on lipid profiles from the Indian subcontinent. Methods: This observational study was conducted at a tertiary care hospital in North Western India. The objective of the study was to find out the adverse effects on lipid profiles after HAART initiation in newly diagnosed HIV-infected children of immune stage III and IV in the 18 months to 16 year age group. These 43 children were evaluated every 3 months for lipid profile for 1 year. Results: There was a nonsignificant increase in total lipid and phospholipid levels and a statistically significant increase in triglycerides (TGs), cholesterol, low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) levels after initiation of HAART therapy and a statistically significant decline in high-density lipoprotein (HDL) level after initiation of HAART therapy in immune phase III. The mean level of total lipid profile, phospholipids, cholesterol, HDL, LDL, VLDL, and TGs before starting of treatment was 474 mg/dl, 147 mg/dl, 126.8 mg/dl, 44.7 mg/dl, 94.3 mg/dl, 22.9 mg/dl, and110 mg/dl in immune stage IV, respectively. After starting treatment, the mean level of total lipid profile, phospholipids, cholesterol, HDL, LDL, VLDL, and TGs was 495.7 mg/dl, 164 mg/dl, 146.5 mg/dl, 38.9 mg/dl, 108.5 mg/dl, 28.9 mg/dl, and 127.3 mg/dl in immune stage IV, respectively. There was a statistically significant increase in total lipid, TG, phospholipid, cholesterol, LDL, and VLDL levels. There was a statistically significant decline in HDL level after initiation of HAART therapy in immune stage IV. Conclusions: We concluded that there was a significant alteration in lipid profile in HIV-infected children of immune stage III and IV with HAART.

Quantification of Oral Candidal Carriage Rate and Prevalence of Oral Candidal Species in HIV Patients with and Without Highly Active Antiretroviral Therapy.

Background:Most documents review decrease in the prevalence of HIV related oral lesions to the tune of 10-50% following the advent of HAART. However long term use of HAART on oral health status of HIV infected subjects is poorly documented. Also antifungal agents can effectively treat mucosal candidiasis. However their use can lead to colonization with less susceptible strains among normal susceptible strains.Aims and Objectives:To know the candidal carriage rate (i.e. presence/absence of candidal growth), candidal density(CFUs/ml) & species variations (species diversity) in HIV positive individuals with and without highly active anti-retroviral therapy (HAART), attending the regional voluntary Counselling and Confidential Testing Centre (VCCTC).Materials and Methods:The study population were categorized into 3 groups. Method followed were Germ tube test, Chlamydospore formation test, CHROM-Agar test.Results:Quantification comparison study of candidal carriage rate, density with detection of various candidal species in the oral cavity of HIV-positive individuals with and without HAART therapy was conducted.Conclusion:HIV positive individuals with HAART therapy treatment prooved higher candidal carriage rate and lower density than Non-HAART category.

Excisional lipectomy versus liposuction in HIV-associated lipodystrophy.

BackgroundHuman immunodeficiency virus (HIV)-associated lipodystrophy is a known consequence of long-term highly active antiretroviral therapy (HAART). However, a significant number of patients on HAART therapy were left with the stigmata of complications, including fat redistribution. Few studies have described the successful removal of focal areas of lipohypertrophy with successful outcomes. This manuscript reviews the outcomes of excisional lipectomy versus liposuction for HIV-associated cervicodorsal lipodystrophy.MethodsWe performed a 15-year retrospective review of HIV-positive patients with lipodystrophy. Patients were identified by query of secure operative logs. Data collected included demographics, medications, comorbidities, duration of HIV, surgical intervention type, pertinent laboratory values, and the amount of tissue removed.ResultsNine male patients with HIV-associated lipodystrophy underwent a total of 17 procedures. Of the patients who underwent liposuction initially (n=5), 60% (n=3) experienced a recurrence. There were a total of three cases of primary liposuction followed by excisional lipectomy. One hundred percent of these cases were noted to have a recurrence postoperatively, and there was one case of seroma formation. Of the subjects who underwent excisional lipectomy (n=4), there were no documented recurrences; however, one patient’s postoperative course was complicated by seroma formation.ConclusionsHIV-associated lipodystrophy is a disfiguring complication of HAART therapy with significant morbidity. Given the limitations of liposuction alone as the primary intervention, excisional lipectomy is recommended as the primary treatment. Liposuction may be used for better contouring and for subsequent procedures. While there is a slightly higher risk for complications, adjunctive techniques such as quilting sutures and placement of drains may be used in conjunction with excisional lipectomy.

MYCOPLASMA GORDONAE: A RARE CAUSE OF ARDS IN THE IMMUNOCOMPROMISED

TOPIC: Chest Infections TYPE: Fellow Case Reports INTRODUCTION: Mycobacterium gordonae, a commonly found species of mycobacteria. While frequently encountered in the environment and clinical laboratories it is almost always considered nonpathogenic. Despite being a non-virulent organism, there are many cases of clinically significant disease. Occasionally, it has been known to cause severe infections, especially in patients with an underlying predisposition or immunosuppression such as AIDS. CASE PRESENTATION: A 39-year-old male with no known PMH presents to the hospital with complaint of worsening dyspnea, fever, and nonproductive cough. He was in his usual state of health until 3 weeks prior when he began to experience body aches, sore throat, fever and shortness of breath. Continued symptoms prompted visit to the hospital at which time he discharged from the emergency department. The patient continued to have progressive worsening of dyspnea with fever prompting return to the hospital and subsequent admission for acute hypoxic respiratory failure. He lives at home with his wife and 4 children who do not have similar symptoms. He has lived in the US for 17 years and denies recent travel, sick contacts, history of autoimmune diseases, smoking history, vaping history, drug use, skin rash, joint pain. On admission vital signs and physical exam showed tachycardia and tachypnea with fever and inspiratory rales. Laboratory data including comprehensive metabolic panel and complete blood count with differential was unrevealing. Chest imaging showed diffuse bilateral dense ground glass opacities. Inflammatory markers including D-dimer, Ferritin, LDH, CRP were elevated. Influenza, COVID-19, mycoplasma, legionella antigen resulted negative. Testing for HIV returned positive with a CD4 count of 8. Given the clinical picture the patient was started on steroids, Bactrim, and Highly active antiretroviral therapy (HAART). Bronchoscopy with BAL was performed showing negative cytology, negative GMS-silver stain. However, AFB testing showed positive M. gordonae with fungal culture showing Candida albicans. Prednisone was discontinued and the patient was continued on HAART therapy along with Bactrim and sent for further treatment with Infectious Disease specialists. DISCUSSION: While there are reports of M. gordonae infections involving many organ systems, pulmonary infection is the most common site of symptomatic disease. Common symptoms include cough, weight loss, dyspnea, hemoptysis and fever. In addition to clinical symptoms and radiographic abnormalities, positive cultures from sputum, bronchial wash, transbronchial or lung biopsy are necessary for diagnosis. CONCLUSIONS: M.gordonae is capable of causing significant infections in both immunocompromised and immunocompetent hosts. Although the likelihood of this being a contamination is significant, its isolation should prompt further evaluation especially in those patients who are immunocompromised. REFERENCE #1: Weinberger M, Berg SL, Feurstein IM, Pizzo PA, Witebsky FG. Disseminated infection with Mycobacterium gordonae: Report of a case and critical review of the literature. Clin Infect Dis. 1992;14:1229–1239. REFERENCE #2: Asija A, Prasad A, Eskridge E. Disseminated Mycobacterium gordonae infection in an immunocompetent host. Am J Ther. 2011 May. REFERENCE #3: Brener ZZ, Zhuravenko I, Bergman M. Acute kidney injury in a patient with nontuberculous mycobacterial infections: a case report. Cases J. 2009 Jan 23. DISCLOSURES: No relevant relationships by mohammed halabiya, source=Web Response No relevant relationships by Richard Miller, source=Web Response No relevant relationships by Shawn Pate, source=Web Response

Miracle Herb to Cure HIV-Black Seeds (Nigella Sativa): A Review

The Acquired Immunodeficiency Syndrome (AIDS) damages the immune system and interferes with the body’s ability to fight infections and it is caused by a retrovirus named Human Immunodeficiency Virus (HIV). The patients with HIV/AIDS are currently managed with Highly Active Antiretroviral Therapy (HAART) or a combination Antiretroviral Therapy (cART) which includes Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs), Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs), Protease Inhibitors (PIs), Integrase Strand Transfer Inhibitors (INSTIs), Fusion Inhibitors (FIs) and Chemokine Receptor antagonists (CCR5 antagonists). The World Health Organization (WHO) has suggested systematically testing ethnomedicines against HIV to find more options for the treatment of HIV/AIDS. This review focuses on the potentials of N. sativa in the management of HIV/AIDS. The antiviral potentials of N. sativa have been observed in many in-vivo and in-vitro studies while previous studies have confirmed the immunomodulatory effects of N. sativa. Above all, various pilot studies and case reports have demonstrated that the administration of N. sativa produced complete seroreversion of viral load in many HIV/AIDS patients, miraculously. Hence, N. sativa could be used alone or in combination with HAART therapy to cure the patients with HIV/AIDS.

Do women with HIV/AIDS on anti-retroviral therapy have a lower incidence of symptoms associated with menstrual dysfunction?

BackgroundSymptoms associated with menstruation and endometriosis are common amongst women of reproductive ages and the pathogenesis of these illnesses is postulated to be associated with aberrations in endometrial regeneration, immune response and in endometrial stem cell function. Highly active antiretroviral therapy (HAART) has been shown to enhance events seen in biological aging of tissues, with HIV/AIDS patients enduring the premature appearance of illnesses associated with stem-cell aging. Considering the intricate relationship between dysregulation of stem cell function, in both HAART therapy and in menstrual disorders/endometriosis, we sought to examine the prevalence of menstrual related symptoms (MRS) associated with endometriosis in women on HIV/AIDS therapy. MethodsA menstrual related symptoms (MRS) questionnaire adapted from the British Society of Gynaecological Endoscopists (BSGE) pelvic pain questionnaire, which has been used in both clinical and research setting, was completed by 100 women living with HIV (WLWH) attending a specialist HIV clinic and by 100 women without a diagnosis of HIV attending the Sexual Health clinic (WWH). HIV related demographic details, including results from recent blood tests, were also recorded prospectively from the WLWH. ResultsWLWH were slightly older (37.7 vs. 34.8 years, P = 0.01); with higher BMI (28.9 vs. 24.8, P < 0.001); and were likely to be parous (85% vs. 54% P < 0.001) and non-Caucasian (79% vs 18%) compared with WWH. Most women in both groups had regular periods (77.9% vs. 74.7%), and WLWH were more likely to have a shorter duration of bleeding compared with WWH (81.4% vs 69.3% P = 0.05). However, WLWH were more likely to suffer with pre-menstrual tension compared with WWH (60.8% vs 50.6% P = 0.01). ConclusionOur data suggests that WLWH, despite being older and of higher BMI, have a shorter duration of menstrual bleeding, and we hypothesise that this may possibly be due to the (beneficial) side effects of some HAART components. Further research is needed to explore the effect of HAART on MRS to determine if these therapies could be used in the future as a fertility retaining treatment for MRSs/endometriosis.

Fetal cardiac evaluation in HIV-positive women under HAART therapy in a Romanian hospital.

Human immunodeficiency virus (HIV) is an RNA (ribonucleic acid) virus that causes acquired immunodeficiency syndrome (AIDS). This disease has a major socioeconomical impact. The aim of the present study was to assess the fetal heart structure and function in HIV-positive pregnant women on highly active antiretroviral therapy (HAART). This is a prospective study conducted between January, 2018 and December, 2019. The hearts of fetuses from 14 HIV-positive pregnant women on HAART were assessed. Statistically significant sex-related cardiac changes in HIV-exposed uninfected fetuses of pregnant women on HAART were found. A narrow aorta was detected in female fetuses and a smaller left ventricular transverse diameter in male fetuses. Overall, the myocardial performance index remained unaltered. The impact of antiretroviral therapy on fetal heart seems to be sex-related. Accurate and complete information about the risks and benefits of antiretroviral treatment and management strategies to improve fetal outcomes may also ensure better compliance of the mothers to this treatment.

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.

Particular Aspects on Applying Nanocarbon Quantum Dots for HIV Inhibition and Theranostics: a Review

Viral infection is a globally leading health issue, causing significantly unfavourable mortality with an adversely decreasing socio-economic growth. To solve those infections of global pandemic HIV specifically, the current utilization of highly active antiretroviral therapy (HAART) in human deficiency virus (HIV) theranostics has remarkably improved the life’s duration of patients infected by human immunodeficiency virus (HIV); however, the unfortunate drawbacks in combination with prolonged HAART therapy need to be used continuously along patient’s lifetime. Additionally, RNA virus of COVID-19 is also associated with viral pneumonia and acute respiratory distress syndrome causing significant morbidity and mortality. Meanwhile, many scientific researchers have explored the successive novelty of carbon quantum dots (CQDs) as alternative to HIV or other related viruses theranostics in the field of antiviral drugs research, but the attempt has been still challenging to introduce perfect antiviral CQDs with excellent biocompatibility, drug resistance, and safety at several areas in the virus’s life cycle. On the contrary, CQDs-based nano-therapy is currently promising because those carbon quantum dots had multiple favourable properties, including significant antiviral response effects, water-soluble activity, color-tunable fluorescence, high yield, low cytotoxic behaviour, and promising biocompatibility. In this review, some effectively recent progress of promising CQDs forviral inhibition and theranostics explored by many studies are systematically summarized.

Particular Aspects on Applying Nanocarbon Quantum Dots for HIV Inhibition and Theranostics: a Review

Viral infection is a globally leading health issue, causing significantly unfavourable mortality with an adversely decreasing socio-economic growth. To solve those infections of global pandemic HIV specifically, the current utilization of highly active antiretroviral therapy (HAART) in human deficiency virus (HIV) theranostics has remarkably improved the life’s duration of patients infected by human immunodeficiency virus (HIV); however, the unfortunate drawbacks in combination with prolonged HAART therapy need to be used continuously along patient’s lifetime. Additionally, RNA virus of COVID-19 is also associated with viral pneumonia and acute respiratory distress syndrome causing significant morbidity and mortality. Meanwhile, many scientific researchers have explored the successive novelty of carbon quantum dots (CQDs) as alternative to HIV or other related viruses theranostics in the field of antiviral drugs research, but the attempt has been still challenging to introduce perfect antiviral CQDs with excellent biocompatibility, drug resistance, and safety at several areas in the virus’s life cycle. On the contrary, CQDs-based nano-therapy is currently promising because those carbon quantum dots had multiple favourable properties, including significant antiviral response effects, water-soluble activity, color-tunable fluorescence, high yield, low cytotoxic behaviour, and promising biocompatibility. In this review, some effectively recent progress of promising CQDs forviral inhibition and theranostics explored by many studies are systematically summarized.

AN UNUSUAL CASE REPORT OF SARCOIDOSIS IN AN HIV PATIENT

SESSION TITLE: Fellows Diffuse Lung Disease Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Coexistence of sarcoidosis in HIV patient is a rare phenomenon and has been attributed to the impairment of immune system that may interfere with granuloma formation.(1) We present an unusual case report of sarcoidosis in HIV patient. CASE PRESENTATION: 58-year-old female with history of HIV on highly active antiretroviral therapy (HAART) (CD4 count: 746 and viral load <20/ml) presented with incidental basilar pulmonary nodules during work up for abdominal pain. Subsequent CT chest showed multiple nodular densities in all lung fields with hilar and mediastinal lymphadenopathy. She is lifetime nonsmoker and had no respiratory symptoms. PET-CT showed avid mediastinal lymph nodes and bone lesions. Bronchoscopy with EBUS guided TBNA was inconclusive with negative fungal and mycobacterial cultures. Thereafter, IR guided bone biopsy was pursued which revealed non-caseating ” naked ” granulomas. Diagnosis of sarcoidosis was established after excluding other granulomatous inflammation, infection, and malignancy. No treatment was initiated as the patient was asymptomatic. DISCUSSION: The introduction of HAART has led to sustained increase in CD4+ T lymphocyte cells, consequently leading to the development of so called “immune restoration disease”. Sarcoidosis is an immune mediated systemic disease resulting from exaggerated cellular immune response to a variety of antigens or self-antigens, in which T lymphocyte triggering, proliferation, and activation is sustained by the CD4+ type 1 (TH1) lymphocytes. TH1 cells produce IFN-?, IL-2, and TNF leading to attraction and activation of mononuclear phagocytes that induce granuloma formation. These immunological features are not clearly exhibited in coexistent sarcoidosis/HIV infection. Before HAART therapy, reports indicated a prevalence of lymphocytic alveolitis due to an increase in CD8 cells, with a very low CD4/CD8 ratio. In a retrospective cohort study, it was concluded that the development of sarcoidosis appears to depend on preservation or restoration of peripheral CD4+ lymphocyte count exceeding 200 cells/µl compared to alternative specific etiologies of granulomatous inflammation.(2) It is worth noting that in all reported clinical cases, sarcoidosis developed several months after HAART therapy compared to acute onset of other typical immune reconstitution syndromes.(1) The need to initiate steroid therapy, as in other immune reconstitution granulomatous processes, remains controversial and is based on patient’s symptoms. CONCLUSIONS: Our case highlights the importance of considering “immune restoration disease” including sarcoidosis and other granulomatous inflammation/infection in HIV patient on HAART therapy with abnormal chest imaging in addition to slow growing lymphoproliferative disorder. Reference #1: Sarcoidosis and HIV infection: a case report and a review of the literature, Postgrad Med J. 2003;79:535–38 Reference #2: Sarcoidosis Following HIV Infection, Chest 2003 Sep; 124 (3), 929–935 DISCLOSURES: No relevant relationships by Moises Cossio, source=Web Response No relevant relationships by Domingo Franco-Palacios, source=Web Response No relevant relationships by Kushagra Gupta, source=Web Response No relevant relationships by Shahzad Hussain, source=Web Response No relevant relationships by Venkateswara Kollipara, source=Web Response No relevant relationships by Toribiong Uchel, source=Web Response