HIV-infected Patients Research Articles

Clinical features and risk factors of HIV-infected patients with intracerebral hemorrhage: a retrospective study with propensity score matching analysis

PurposeTo investigate the clinical features and risk factors of the human immunodeficiency virus (HIV)-infected patients with intracerebral hemorrhage (ICH).Patients and methodsThe patients with HIV-infected without ICH group were matched to the group of HIV-infected ICH patients. Logistic regression analysis using 1:1 propensity score matching (PSM) was performed to investigate the independent risk factors for ICH in HIV-infected patients. The receiver operating characteristic (ROC) curve was configured to calculate the optimal predictors of ICH in HIV-infected patients.ResultsA total of 59 HIV-infected patients with ICH and 180 HIV-infected patients without ICH were included. A cohort of 118 patients was ascertained utilizing PSM. Multivariate binary logistic regression analysis revealed that drug abuse-related HIV-infected, prolonged prothrombin time (PT), and elevated triglyceride (TG) levels were independent risk factors of ICH in HIV-infected patients. The ROC curve demonstrated that the combined predictor, composed of drug abuse-related HIV-infected, prolonged PT, and elevated TG levels, exhibited the highest area under the curve (AUC), with a cut-off point at 0.426, sensitivity of 78%, and specificity of 81.4%.ConclusionThe present study revealed that a valuable factor combined with drug abuse-related HIV-infected, prolonged PT, and elevated serum TG levels could serve as predictors of ICH in HIV-infected patients.

Monkeypox-related knowledge and vaccination willingness among HIV-diagnosed and -suspected males: a cross-sectional survey in Changsha

ObjectiveThis study aimed to update baseline data on monkeypox (mpox)-related knowledge and vaccination willingness among human immunodeficiency virus (HIV) diagnosed and suspected males.MethodsThe cross-sectional survey was conducted in Changsha, a provincial capital in China, during 5 JULY to 5 SEPTEMBER 2023. Among the three study groups, the participants in the “previously diagnosed” group were recruited from a cohort of HIV-infected patients. The “newly diagnosed” and the “suspected” groups were recruited from the outpatients and grouped according to their confirmatory test results. The the exploratory factor analysis was firstly applied to capture the latent structure of participants’ response to the questionnaire about monkeypox. The component and factor scores were compared between groups using the Kruskal-Wallis H tests. The chi-square test was then used to assess the difference of mpox vaccination willingness between MSM and non-MSM in each group. Finally, multivariate logistic regression analysis was performed to identify the determinants of vaccination willingness.ResultsA total of 481 males were included in the final analysis. The results revealed that there was a gap in knowledge about monkeypox between the three participant groups. The vaccination willingness rate of HIV-infected participants was above 90%, while the rate in the HIV-suspected group was 72.60%. Multivariate logistic regression analysis revealed that the previously diagnosed group (adjusted odds ratio [aOR] = 0.314, 95% confidence interval [CI]: 0.105–0.940) and the suspected group (aOR = 0.111, 95% CI: 0.034–0.363) had a lower level of vaccination willingness and they were referred to the newly diagnosed group. Participants in the age groups ranging 25–34 (aOR = 0.287, 95% CI: 0.086–0.959) and 35–44 (aOR = 0.136, 95% CI: 0.039–0.478) years showed a lower level of vaccination willingness, referred to the 15–24 year age group. A better knowledge about monkeypox was associated with a higher level of vaccination willingness (aOR = 1.701, 95% CI: 1.165–2.483). Additionally, a considerable percentage of heterosexual individuals in each group indicated their acceptance of monkeypox vaccines.ConclusionAn overall high level of vaccination willingness was observed among HIV-infected and-suspected male individuals with disparities noted among those with different HIV infection status, knowledge levels of monkeypox, and age. Addressing the existing knowledge gap and engaging people with persistent risks—regardless of their sexual orientation—for a timely HIV diagnosis may facilitate vaccine-based mitigation measures against monkeypox.

Assessment of Antiretroviral Therapy Adherence Among HIV/AIDS Patients at Jugel Hospital, Harar, Ethiopia. 2021

Background: HIV/AIDS remains a major global health concern, significantly impacting not only health systems but also economic development and social fabric; it reduces life expectancy, exacerbates poverty, and contributes to food insecurity. While the introduction of Highly Active Antiretroviral Therapy (HAART) has improved the lives of people living with HIV, strict adherence to treatment regimens is crucial to maintain its effectiveness and prevent the development of drug resistance. Objective: To assess ART adherence among HIV/AIDS patients at Jugol Hospital, Harar, Ethiopia. Method: A cross-sectional descriptive study design was employed using a quantitative approach to determine the status of ARV adherence among HIV patients at Jugel Hospital from February 20, 2021, to March 10, 202. A convenience sampling technique was used to select the study subjects. The study covered all consecutive patients who attended the ART at Jugel Hospital for medication refills over the study period. Results: Of the total 210 HIV-infected patients, the largest number were females, 62%, and belonged to the 26-35 age group, 112 (53.4%). Out of the 210 respondents, the majority, 129(61.4%), used cell phone alarms/watch bells for memory aids to take their medication on time. Most respondents thought that for more Adherence to ART, people need family and other support, education about the importance of medication and schedule aids, an understanding of the importance of adhering, and a belief in the efficacy of medication. Of the total, only 34 respondents had a history of missed doses after they had started ART. The main reasons for missed doses were forgetting 14(41.2%), being busy 9(26.3%), run out of pills 4(11.7%), fear of taking medication in front of others 5(14.7%) and side effects 2(5.9%). The main reasons that made the patients not follow and attend their clinical appointments regularly were forgetting 12(48%), being away from home 7(28%) and being busy 6(24%). Conclusion: In our study, the self-reported adherence rate was higher than in industrialized nations. Regular patient follow-up, raising patients' understanding of ARV adverse effects, and enhancing patients' confidence, trust, and happiness with their caregivers are all goals of programs and clinical initiatives to promote drug taking in study setups.

Determination of cryptococcal antigen in newly diagnosed HIV infected patients attending Specialist Hospital Sokoto North-Western Nigeria

Abstract Cryptococcal Meningitis (CM), an infection and inflammation of the meninges, predominantly affects individuals with compromised immune systems, particularly HIV/AIDS patients. This study aims to assess the CD4 count of newly diagnosed HIV patients, prevalence of cryptococcal antigen in those with low CD4 counts, and socioeconomic risk factors associated with cryptococcal diseases in Sokoto, Nigeria. A cross-sectional study was conducted among 154 newly diagnosed HIV-positive patients at Specialist Hospital Sokoto, utilizing blood samples for CD4 count and cryptococcal antigen detection via lateral flow assay. The study found that 38.2% of patients with CD4 < 200 cells/µL were positive for cryptococcal antigen, highlighting a significant association between low CD4 count and cryptococcal infection (p value 0.000). The prevalence was highest among the 31–40 years age group (47.6%) and married individuals (61.9%), although no significant associations were found with age or marital status. Socioeconomic factors revealed higher prevalence among Hausa/Fulani (85.7%) and individuals with informal education (66.7%). The study underscores the necessity of routine cryptococcal antigen screening in HIV clinics to reduce CM-related morbidity and mortality. Early diagnosis and preventive interventions are crucial to address the substantial burden of cryptococcal infection among HIV patients in Sokoto State, Nigeria.

Structure of mycoses of the skin and its appendices in HIV-infected patients

The spread of HIV infection is one of the most pressing problems of modern health care. The purpose of the work is to analyze the structure of the disease on the surface of the skin and its appendages by the nosological forms in HIV-infected persons and to establish a possible correlation between the presence of fungal lesions. The data obtained from 801 patients who sought medical help at the «Chernivtsi Regional Medical Center for Socially Significant Diseases» for the period from 2018 to 2023 were analyzed. The diagnosis of HIV infection was established according to the International Classification of Diseases of the 10th revision (ICD-10) and verified by the detection of specific serological and molecular biological markers of HIV. Mycological examination included micro­scopy of pathological material and cultural diagnosis. Analysing the structure of the disease it was found that skin mycoses and its appendages were detected in 334 (41,7%) HIV-infected patients. The main part of such patients – 237 (71%) – did not receive antiretroviral therapy (ART). Accordingly, dermatomycosis was detected in only 97 people (29%) who were adherent to ART. The relative risk method confirms the assessment of the effect of ART on the frequency of combined forms of mycosis – RR=0.608, which indicates the obvious rarity of the event (mycosis of the skin and its appendages), compared to the group that did not receive ART. A statistically significant direct relationship was established between the presence of a fungal skin lesion and its applications and indicators of HIV load in the blood – r=0.421...0.460 at p<0.001, as well as the duration of HIV infection – r=0.573...0.611 at p<0.01 . In addition, there is a clear positive correlation of medium strength between the duration of HIV infection and the level of viremia – r=0.388...0.427 at p<0.01, as well as an inverse weak relationship with the number of CD4+-lymphocytes – r=-0.105. ..-0.204 at p<0.05. The number of CD4+-lymphocytes was expected to be in an inverse correlation of medium strength with the HIV load (r=-0.618...-0.682, p<0.01). The relative risk of the development of mycoses of the skin and its applications in HIV-infected patients under the condition of antiretroviral therapy is only 0.262 (0.225-0.298), which indicates an obvious rarity of the event, compared to the group that did not receive antiretroviral therapy. The majority of HIV-infected patients (62.3%) have a combination of several nosological forms of mycosis of the skin and its applications. A strong inverse relationship between the probability of developing combined forms of mycoses and receiving antiretroviral therapy was revealed – r=-0.719...-0.806 at p<0.001. In the absence of antiretroviral therapy, a statistically significant direct relationship was established between the presence of fungal lesions of the skin and its appendages and indicators of HIV load in the blood, as well as the duration of HIV infection.

Drug-Drug Interactions Between HIV Antivirals and Concomitant Drugs in HIV Patients: What We Know and What We Need to Know

Highly active antiretroviral therapy has led to a significant increase in the life expectancy of people living with HIV. The trade-off is that HIV-infected patients often suffer from comorbidities that require additional treatment, increasing the risk of Drug-Drug Interactions (DDIs), the clinical relevance of which has often not been determined during registration trials of the drugs involved. Therefore, it is important to identify potential clinically relevant DDIs in order to establish the most appropriate therapeutic approaches. This review aims to summarize and analyze data from studies published over the last two decades on DDI-related adverse clinical outcomes involving anti-HIV drugs and those used to treat comorbidities. Several studies have examined the pharmacokinetics and tolerability of different drug combinations. Protease inhibitors, followed by nonnucleoside reverse transcriptase inhibitors and integrase inhibitors have been recognized as the main players in DDIs with antivirals used to control co-infection, such as Hepatitis C virus, or with drugs commonly used to treat HIV comorbidities, such as lipid-lowering agents, proton pump inhibitors and anticancer drugs. However, the studies do not seem to be consistent with regard to sample size and follow-up, the drugs involved, or the results obtained. It should be noted that most of the available studies were conducted in healthy volunteers without being replicated in patients. This hampered the assessment of the clinical burden of DDIs and, consequently, the optimal pharmacological management of people living with HIV.

THE FIRST SUCCESSFUL EXPERIENCE OF HIGH-DOSE CHEMOTHERAPY FOLLOWING AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION FOR HODGKIN LYMPHOMA IN A PATIENT WITH HIV INFECTION AT THE PIROGOV NATIONAL MEDICAL AND SURGICAL CENTER

The risk of developing Hodgkin Lymphoma (HL) is 5 to 26 times higher in HIV-infected patients compared to the general population. HL can develop even with moderate immune suppression and treatment with antiretroviral medicines. This article reviews the current treatment strategy for HL in HIV-infected patients and describes the first successful experience of high-dose chemotherapy following autologous hematopoietic stem cell transplantation (autoHSCT) in an HIV-infected patient at the Hematology Department of the Pirogov National Medical and Surgical Center. This clinical case demonstrates the efficacy and safety of autoHSCT for treatment of relapsed and refractory HL in patients with HIV infection.

High Cryptococcal Antigenuria Prevalence in a Population of PLHIV with Neurological Symptoms Hospitalized in the Infectious Diseases Wards of the Centre Hospitalier Universitaire de Libreville, Gabon.

Introduction: Cryptococcal meningitis is a major cause of death in HIV/AIDS patients due to the existence of Cryptococcus neoformans in the central nervous system. Our objective was to evaluate the prevalence of Cryptococcus antigenuria in a population of HIV-infected patients in Libreville, Gabon. Patients and Methods: This study was conducted from April to October 2021 at the Infectious Diseases ward of the Centre Hospitalier Universitaire de Libreville. Hospitalized patients with HIV were included. The detection of cryptococcal antigen (CrAg) in urine was performed using the Pastorex Crypto Plus Kit. Results: Out of the 255 PLHIV, 142 benefited from the CrAg detection. The prevalence of urine CrAg was 24.6% (n = 35). The majority of CrAg+ patients (82.8%; n = 29) were under 55 years old. Almost three-quarters of them (n = 25; 71.4%) had CD4 counts < 200, and 80.0% (n = 28) were at WHO clinical stages III and IV. All patients with neck stiffness at admission had a CrAg positive test. Conclusion: This study showed a non-negligible prevalence of Cryptococcal urinary antigen in HIV-infected patients with neurological symptoms. These data underline the importance of CrAg screening in routine care for better management of PLHIV.

Assessment of the relationship between Epstein–Barr virus major types and genovariants as well as clinical and laboratory parameters in HIV-infected adults

Introduction. People living with human immunodeficiency virus (HIV) are more likely to experience Epstein–Barr virus (EBV) reactivation and develop EBV-associated diseases. In Russia, the clinical significance of EBV genetic diversity in HIV-infected patients has not been assessed. The aim was to analyze a relationship between the major EBV types and LMP-1 genovariants with clinical and laboratory parameters in HIV-infected persons. Materials and methods. Peripheral blood leukocytes were collected from 138 HIV(+) individuals aged 20–69 years. Association between EBV types, LMP-1 variants and subvariants with clinical and laboratory parameters (CD4+ T-lymphocyte count, HIV and EBV viral load, use and adherence to antiretroviral therapy (ART)), was performed using the principal component analysis method and the Mann–Whitney U test. Results. It has been shown that detectable HIV viral load increases in patients with low CD4+ T-lymphocyte counts, high EBV viral load, and low or no ART adherence. In general, infection with EBV-2 or the LMP-1 B95-8 alone resulted in lower EBV and HIV viral loads compared with other variants. Significant EBV-1 LMP-1 subvariants were identified, the biological potential of which was enabled in immunodeficiency state (CD4+ T-lymphocyte count ≤ 200 cells/μl). In “naive” patients, EBV-1/LMP-1 (S309N)+HIV co-infection occurred with a higher, and EBV-1/LMP-1(E328Q)+HIV with the lowest HIV viral load. The highest EBV DNA concentrations were observed with EBV-1/LMP-1(Q334R)+HIV. In “experienced” patients, the level of EBV DNA was significantly lower when infected with EBV-1/LMP-1(E328Q)+HIV and, conversely, higher in case of detected EBV-1/LMP-1(H358P)+HIV. Conclusion. The features of clinical and laboratory parameters EBV+HIV co-infection caused by different EBV-1 LMP-1 subvariants (at the level of amino acid substitutions S309N, E328Q, Q334R, H358P) have been identified. It is necessary to study the functional role of such mutations in vitro and in vivo. In the context of assessing a clinical significance of EBV molecular genetic diversity, it is advisable to conduct larger-scale studies in different territories of Russia.

Comparison of Standard and Point-of-Care CD4+ T Lymphocyte Measurement Methods in HIV-1 Infected Turkish Patients.

Background and Objectives: CD4+ T lymphocytes are the primary targets of HIV infection. CD4+ T lymphocyte count is an indicator of immune competence. In this study, we aimed to compare standard flow cytometry and point-of-care (POC) CD4+ T lymphocyte in terms of cost, effectiveness, reliability, time, and the use of this method for disease. Materials and Methods: This study includes 113 patients. CD4+ T lymphocyte count and percentage were evaluated by flow cytometry and POC. Also, hemoglobin (Hb) level was studied. The data obtained by two methods are compared. Results: When the two methods were compared, intraclass coefficients demonstrated a good consistency for Hb (ICC = 0.849) and CD4+ T lymphocyte percentage (ICC = 0.803). For CD4+ T lymphocyte count, consistency was moderate, ICC = 0.651, but still statistically significant (p < 0.001). Conclusions: In resource-limited countries, virological monitoring with HIV RNA cannot be performed at any time because it is expensive. However, CD4+ T lymphocyte count and percentage monitoring is important in predicting treatment success. POC results are in good consistency with the standard method, and it is also a test that can be used due to being cheap, easy, and quick.

HIV/AIDS KNOWLEDGE IMPROVES ANTIRETROVIRAL DRUG COMPLIANCE

Antiretroviral (ARV) therapy compliance is very important for people living with HIV/AIDS (PLWHA) and their support group. Effective ARV medication was essential for HIV infected patients to improve their health, reduce progression, reduce HIV drug resistance, prolong patient life expectancy, and decrease risk of HIV/AIDS transmission to others. Many factors caused non-adherence to ARV drugs. This study aimed to determine the relationship between education, HIV/AIDS knowledge level and ARV compliance. This study was cross-sectional design using consecutive non-random sampling with total sample of 34 subjects. Data were collected using questionnaire. The number of subject conducted in Public Heatlh Center of Cibatu District, Cikarang, Indonesia from October to November 2018. Chi-Square and Fisher test was used to analysed data. Most of the respondents were males, 20-25 years old, intermediate education, HIV/AIDS knowledge level was high, and had good ARV compliance level. There was a significant relationship between education, HIV/AIDS knowledge and ARV medication compliance.

Analysis of Subtype, Molecular Clusters and Drug Resistance in Newly Diagnosed Individuals with HIV-1 Infection in Jiaxing City, Zhejiang Province, China in 2023

The analysis of the molecular epidemiological characteristics of newly diagnosed HIV-infected patients in Jiaxing City is essential for developing effective HIV prevention. Blood samples were collected from newly diagnosed HIV-infected individuals in Jiaxing City from October 2022 to October 2023, and the HIV-1 pol region gene was amplified and sequenced. These sequences were used to construct a molecular transmission network and analyse transmitted drug resistance mutations. We identified 11 subtypes, of which CRF07_BC and CRF01_AE were the most prevalent. The rate of surveillance drug resistance mutation (SDRM) sites in newly diagnosed cases was 9%. A total of 37 molecular transmission clusters were identified, the largest of which was the CRF07_BC-1 cluster (13 nodes). This cluster has five probable high-risk transmitters. Two additional larger clusters in the molecular network were the heterosexual transmission clusters for middle-aged and older males, CRF08_BC-1 (eight nodes) and CRF85_BC-1 (eight nodes). The mean degree of the two clusters was high, and the patients were high-risk transmitters, indicating a higher risk of HIV transmission. The distribution of HIV-1 subtypes in Jiaxing City was widespread, with moderate levels of transmission resistance. Larger molecule clusters carry a high risk of transmission, indicating that we should strengthen monitoring and intervention.

The value of metagenomic next-generation sequencing with blood samples for the diagnosis of disseminated tuberculosis

ObjectiveThe aim of this study was to assess the clinical value of metagenomic next-generation sequencing (mNGS) of blood samples for the identification of disseminated tuberculosis (DTB).MethodsA total of 48 individuals suspected of DTB were enrolled. All patients underwent mNGS of peripheral blood and conventional microbiological tests. Patient characteristics were collected from their medical records.ResultsA total of 28 patients were diagnosed with DTB, whereas 20 patients were confirmed as non-DTB cases. In the DTB groups, 19 (67.9%) contained TB sequences, with specific reads of TB ranging from 1 to 219. The TB sequence was more detectable by mNGS in male patients, those with elevated PCT levels, those who are HIV positive, and those with a decreased CD4 T-cell count. The HIV-positive group shows higher TB mNGS reads (p = 0.012) and TB mNGS sensitivity (p = 0.05). The sensitivity of TB mNGS in blood samples was 80% for HIV-infected patients and 44.4% for non-HIV-infected individuals (p = 0.05). The non-HIV group had a higher prevalence of miliary tuberculosis (p = 0.018), and extrapulmonary tuberculosis was more prevalent in the HIV-positive group.ConclusionOur research has shown that the mNGS of blood samples has excellent sensitivity for the diagnosis of DTB. The TB sequence was more detectable by mNGS in patients with elevated PCT levels, those who are HIV positive, and those with a decreased CD4 T-cell count.

Health Promoting Properties of Vitamins C and D Against HIV Disease Progression, a Narrative Review

Human immunodeficiency virus (HIV) has troubled humankind for many years. The rate of new HIV cases is decreasing steadily, mostly because of safer sexual practices and scientific advances in medicine. However, the number of HIV-related trials has significantly increased, as the search for a definite cure for HIV is still fruitless. Our current treatment options involve antiretroviral therapy (ART) with various drug combinations that lower the patients’ viral load in order for the immune system to reconstitute itself. This way, adherent patients achieve a life expectancy similar to the general population. Besides the established treatment protocols, the focus has currently shifted towards secondary pharmaceutical regimen programs that enhance a patient’s immune system and response to opportunistic infections. Vitamins C and D are easily obtainable even in the developing world and are known to improve an individual’s daily life, with vitamin D enhancing the human immune response and vitamin C having an assisting role in both the immune response and as an important antioxidant. Recently, many studies assessing the effect of these vitamins on the progression of HIV have been performed. We aimed to collect and review these studies in order to determine the necessity of the supplementation of these vitamins in HIV-infected patients, which might complement the existing ART. To this day, the scientific community is conflicted, and more studies must be conducted before a definite conclusion about these vitamins’ effects on HIV patients can be reached.

QTc interval prolongation and its associated factors among HIV infected patients on ART in Mettu Town

QTc interval prolongation, which is linked to cardiac arrhythmia and sudden cardiac death, is common in HIV-infected patients. This prolongation can be attributed to the side effects of antiretroviral medications, the direct impact of HIV on the heart, and chronic inflammatory responses that disrupt cardiac electrical activity. This study aimed at assessing QTc interval prolongation and associated factors among HIV-infected adults on ART. A cross-sectional study was conducted among consecutively selected 298 HIV-infected patients at Mettu Karl Specialized Hospital, southwest Ethiopia. A face-to-face interview with a structured and pretested questionnaire was employed to collect socio-demographic and behavioural characteristics data. Electrocardiography was done using a 12-lead electrocardiograph, and interpreted by a cardiologist. Data were entered into Epi-data version 4.6 and analyzed using SPSS version 25. Multivariable logistic regression analyses were done at a significance level of P < 0.05. QTc prolongation was prevalent in 12.4% of participants. Being on PIs containing HAART regimen (AOR = 5.7, 95%CI 2.54–12.8), having recent CD4 count of < 350 cells/mm3 (AOR = 4.8, 95%CI 2.19–10.5), and recent viral load of ≥ 1000coppies/ml (AOR = 2.8, 95%CI 1.24–6.42) were significantly associated with QTc prolongation. According to this study, one of the ten HIV-infected patients on ART had QTc prolongation. Therefore, we suggest that HIV-positive patients receiving treatment should undergo screening for QTc interval prolongation.

A web-based dynamic nomogram for estimating talaromycosis risk in hospitalized HIV-positive patients.

Our study aimed to develop and validate a nomogram to assess talaromycosis risk in hospitalized HIV-positive patients. Prediction models were built using data from a multicentre retrospective cohort study in China. On the basis of the inclusion and exclusion criteria, we collected data from 1564 hospitalized HIV-positive patients in four hospitals from 2010 to 2019. Inpatients were randomly assigned to the training or validation group at a 7:3 ratio. To identify the potential risk factors for talaromycosis in HIV-infected patients, univariate and multivariate logistic regression analyses were conducted. Through multivariate logistic regression, we determined ten variables that were independent risk factors for talaromycosis in HIV-infected individuals. A nomogram was developed following the findings of the multivariate logistic regression analysis. For user convenience, a web-based nomogram calculator was also created. The nomogram demonstrated excellent discrimination in both the training and validation groups [area under the ROC curve (AUC)=0.883 vs. 0.889] and good calibration. The results of the clinical impact curve (CIC) analysis and decision curve analysis (DCA) confirmed the clinical utility of the model. Clinicians will benefit from this simple, practical, and quantitative strategy to predict talaromycosis risk in HIV-infected patients and can implement appropriate interventions accordingly.

Multi-Locus Sequence Typing-Based Genetic Analysis, Antifungal Resistance, and Clinical Prognosis of Cryptococcus neoformans Infections in HIV-Infected Patients in Northern China.

This study aimed to investigate the molecular epidemiological characteristics and drug sensitivity of Cryptococcus from HIV-infected patients and their relationship with patients' prognosis. Seventy-six strains were collected and identified to the species level by matrix-assisted laser desorption ionization-time of flight mass spectrometry, confirmed by internal transcribed spacer sequencing. Multi-locus sequence typing was used for the typing of Cryptococcus, and its antifungal susceptibility was tested using FUNGUS 3. The clinical outcomes of the patients were reviewed at 3-, 6-, 9-, and 12-month follow-ups. All strains were Cryptococcus neoformans var. grubii classified into seven sequence types (STs) dominated by ST5, ST31, and a new ST702 strain. The 6- and 9-month survival rates were highest for patients infected with ST31, ST32, and ST174. The antifungal resistant rates were 13.2%, 2.6%, and 1.4% for fluconazole, amphotericin B, and 5-fluorocytosine. Except itraconazole, the minimum inhibitory concentration (MIC) values and wild type (WT)/non-wild type (NWT) of Cryptococcus for antifungal drugs were not related to the clinical prognosis of HIV-infected patients with cryptococcal infection. ST5 was the main ST type, and the new ST702 type was found in a patient who died in a short period of time. Cryptococcus neoformans var. grubii had a relatively high antifungal drug resistance rate to fluconazole. The WT strain accounted for the highest proportions for 5-fluorocytosine, amphotericin B, fluconazole, voriconazole, and itraconazole. The MIC values of Cryptococcus for first-line antifungal drugs showed no relationship with clinical prognosis, implying that MIC values cannot be used to predict the clinical outcome of these patients.

Same-day identification and genotypic antibiotic resistance testing of Mycobacterium tuberculosis complex and non-tuberculous mycobacteria from positive blood culture bottles – a proof of principle assessment

Background and Aims: patients suffering from systemic mycobacterial spread are at high risk of unfavorable clinical outcomes. Rapid microbiological diagnosis, however, is complicated due to the very slow cultural growth of mycobacteria. To facilitate the diagnostic workflow, we assessed a workflow allowing mass spectrometry-based identification and molecular resistance testing of mycobacteria directly from blood culture pellets. Materials and Methods: for this study, 50 blood cultures spiked with n=10 Mycobacterium tuberculosis (MTC) isolates and n=40 isolates belonging to 12 other species of non-tuberculous mycobacteria (n=13 M. abscessus complex, n=5 M. avium, n=3 M. chimaera, n=5 M. fortuitum, n=5 M. intracellulare, n=2 M. lentiflavum and n=2 M. mucogenicum, n=1 for each one of the species M. elephantis, M. hassiacum, M. marseillense, M. nebraskense and M. parascrofulaceum) were used next to two clinical cases of a disseminated infection in HIV patients. Results: the application of the MBT Sepsityper® kit allowed the correct species level identification by applying mass spectrometry as well as correct molecular resistance testing results as compared to the diagnostic reference approach applied with mycobacterial culture material. Conclusions: in conclusion, the results provide a proof-of-principle of the suitability of the assessed potential workflow in order to achieve a shortened time-to-result for the diagnosis of systemic mycobacterial infections. Future studies in high endemicity settings are desirable to assess the clinical applicability and impact of such a shortened workflow.

Evolution of Hematobiochemical Profiles in Newly Diagnosed HIV Patients and HIV-TB Co-Infected Patients: Correlation with Immunological and Virological Status.

CD4+ cells, HIV-1 plasma viral load (PVL), and IFN-γ have been observed to enhance susceptibility in TB infection/reactivation among HIV-1 infected people, leading to unusual clinical manifestations. HIV-TB co-infection is significant for immunological and virological response, making it a great clinical challenge for patient management. The objective of this study was to explore the correlation among various hematological and biochemical profiles with CD4+ count and PVL in order to decipher mechanisms of TB development or reactivation in HIV-infected patients. In this cross-sectional study, we included 200 newly diagnosed treatment naïve HIV-1 infected patients, of which 118 were HIV-TB co-infected and 82 were HIV-alone. The CD4+ T count was determined using the BD FACS Count System, and the plasma HIV-1 viral load was estimated using the Abbott m2000 real-time platform. The hematobiochemical testing was performed on fully-automated analyzer ADVIA® 560 and Cobas® 501 Roche Diagnostics. Statistical software SPSS-2, Spearman correlation analysis was used for data analysis and a P-value less than 0.05 was considered statistically significant. Declined hemoglobulin level positively correlated with CD4 counts (r = 0.229; p = 0.001), and a negative correlation was observed with HIV-1 plasma viral load (r = -0.171; p = 0.016). Moreover, the CD4+ count and HIV-1 plasma viral load (PVL) were also correlated to anomalies such as thrombocytopenia, leucopenia, eosinophils, neutrophils, ESR, potassium, Albumin, globulin, SGOT, uric acid. Studies also found significantly higher absolute neutrophil count, ESR, and serum fasting blood sugar, creatine, uric acid, total bilirubin, globulin, and alkaline phosphatase in HIV-TB co-infected patients. The initial value of Hb, ESR, absolute neutrophil counts, serum calcium, uric acid, and potassium can be used as an early indicator for active tuberculosis (TB) and as a substitute marker for the course of HIV disease, especially in areas with low resources.

Amphotericin B Colloidal Dispersion is Efficacious and Safe for the Management of Talaromycosis in HIV-Infected Patients: Results of a Retrospective Cohort Study in China.

Amphotericin B deoxycholate (AmB-D) have potential toxic effects in the treatment of talaromycosis, and high-quality, non-generic liposomal AmB (L-AMB) is still inaccessible in many regions of China. As such, the efficacy and safety of alternative drugs warrant further investigation for the management of talaromycosis. This study aimed to compare the efficacy and safety of Amphotericin B Colloidal Dispersion (ABCD) and AmB-D for the treatment of talaromycosis in a retrospective cohort of HIV-infected patients. This was a retrospective study and the data of HIV-infected patients with talaromycosis who received ABCD or AmB-D from January 2018 to December 2022, were retrospectively collected and analyzed. We compared the efficacy and safety of the two antifungal drugs. Overall, 38 patients receiving ABCD and 33 patients receiving AmB-D were included. The conversion rates to fungal negativity at one week post-treatment were 86.84% (33/38) in the ABCD group and 90.09% (30/33) in the AmB-D group, which reached 100.00% in both groups at two weeks post-treatment. A higher symptom remission rate was observed at two weeks in the ABCD group compared with the AmB-D group (94.74% vs 75.76%; p=0.003). Additionally, the serum creatinine level significantly increased from baseline in the AmB-D group, whereas it did not increase significantly in the ABCD group. Furthermore, significantly fewer patients discontinued antifungal treatment due to drug intolerance in the ABCD group, and the incidences of leukopenia and elevated creatinine levels were lower in the ABCD group compared with the AmB-D group. ABCD has a clinical efficacy comparable to AmB-D, with higher symptom remission rate, lower nephrotoxicity, and lower bone marrow suppression, indicating that ABCD may be an appropriate alternative option for the clinical management of talaromycosis.