HIV Co-infected Patients Research Articles

Targeting ADA and HIV-1 Nef Protein with Protease Inhibitors: A Repurposing Strategy through Molecular Networking and an In silico Approach for Integrated Management of HIV Co-infected with Abdominal Tuberculosis

Background: Background: The co-infection of HIV and abdominal TB poses a worldwide danger to humanity. This is because there are more strains of bacteria that are resistant to many classes of currently available medications. According to current findings, repurposing existing available medications will result in more effective functioning than using newly designed medications. Objective: Based on this fact, we hypothesised that the PI could be repurposed; we used Food and Drug Administration (FDA)-approved PI drugs to treat HIV co-infected patients with abdominal TB, and a computational study has been conducted. Methods: This comprises network analysis models to find their protein drug interaction (PDI) through a search tool for interacting chemicals (STICH) module of Cytoscape network analysis model followed by the screening of these drugs for their ADMET prediction and binding affinity with adenosine deaminase (ADA), a protein responsible for abdominal TB, and the HIV-1 Nef protein, responsible for the regulation of immune function (CD4+). Results: The network analysis showed 13 nearest binding drugs of these proteins of interest. The ADMET study result showed the pharmacologically relevant parameters that have a significant effect on the binding affinity, bioavailability, and toxicity of PI. The top three scores achieved by PI against adenosine deaminase enzyme activity (PDB ID: 1A4M) are viz., -23.7919, -23.3529, and -22.6773 for Ritonavir, Tipranavir, and Atazanavir, respectively. The top three scores achieved by PI against HIV-1 Nef protein activity (PDB ID: 6URI) are viz., -28.7321, -28.4987, and -28.3155 for Atazanavir, Tipranavir, and Simeprevir, respectively. The active site of ADA and HIV-1 Nef proteins comprises amino acid residues such as for Tipranavir: Arene-Cation interaction (Phenyl and Pyridine)- Arg B1081, and Lys B1033 (1A4M) and Arene-Cation interaction (Pyridine and Phenyl)- Lys D11 and Arg D33; Sidechain acceptor Thr B40; Sidechain donor- Asp D30; Backbone donor- Ala B37 (6URI). Atazanavir: Arene-Cation interaction (Phenyl)- Lys A254 and Lys B1033; Sidechain acceptor - Arg A251 (1A4M). Conclusion: Thus, from the computational studies carried out, we could obtain hints for optimising the molecular selectivity of the PI to provide help in the design of new compounds via the repurposing strategy of the FDA-approved PI for effective treatment of co-morbidity with HIV and abdominal TB. However, further pharmacokinetics, pharmacodynamics, preclinical, and clinical studies permit the design of the new agents without undesirable interactions.

Drug-induced hepatotoxicity and association with slow acetylation variants NAT2*5 and NAT2*6 in Cameroonian patients with tuberculosis and HIV co-infection

BackgroundHuman immunodeficiency virus (HIV) and tuberculosis (TB) are major contributors to morbidity and mortality in sub-Saharan Africa including Cameroon. Pharmacogenetic variants could serve as predictors of drug-induced hepatotoxicity (DIH), in patients with TB co-infected with HIV. We evaluated the occurrence of DIH and pharmacogenetic variants in Cameroonian patients.MethodsTreatment-naïve patients with HIV, TB or TB/HIV co-infection were recruited at three hospitals in Cameroon, between September 2018 and November 2019. Appropriate treatment was initiated, and patients followed up for 12 weeks to assess DIH. Pharmacogenetic variants were assessed by allele discrimination TaqMan SNP assays.ResultsOf the 141 treatment naïve patients, the overall incidence of DIH was 38% (53/141). The highest incidence of DIH, 52% (32/61), was observed among HIV patients. Of 32 pharmacogenetic variants, the slow acetylation variants NAT2*5 was associated with a decreased risk of DIH (OR: 0.4; 95%CI: 0.17–0.96; p = 0.038), while NAT2*6 was found to be associated with an increased risk of DIH (OR: 4.2; 95%CI: 1.1–15.2; p = 0.017) among patients treated for TB. Up to 15 SNPs differed in ≥ 5% of allele frequencies among African populations, while 25 SNPs differed in ≥ 5% of the allele frequencies among non-African populations, respectively.ConclusionsDIH is an important clinical problem in African patients with TB and HIV. The NAT2*5 and NAT2*6 variants were found to be associated with DIH in the Cameroonian population. Prior screening for the slow acetylation variants NAT2*5 and NAT2*6 may prevent DIH in TB and HIV-coinfected patients.

Persistent T cell unresponsiveness associated with chronic visceral leishmaniasis in HIV-coinfected patients

A large proportion of HIV-coinfected visceral leishmaniasis (VL-HIV) patients exhibit chronic disease with frequent VL recurrence. However, knowledge on immunological determinants underlying the disease course is scarce. We longitudinally profiled the circulatory cellular immunity of an Ethiopian HIV cohort that included VL developers. We show that chronic VL-HIV patients exhibit high and persistent levels of TIGIT and PD-1 on CD8+/CD8- T cells, in addition to a lower frequency of IFN-γ+ TIGIT- CD8+/CD8- T cells, suggestive of impaired T cell functionality. At single T cell transcriptome and clonal resolution, the patients show CD4+ T cell anergy, characterised by a lack of T cell activation and lymphoproliferative response. These findings suggest that PD-1 and TIGIT play a pivotal role in VL-HIV chronicity, and may be further explored for patient risk stratification. Our findings provide a strong rationale for adjunctive immunotherapy for the treatment of chronic VL-HIV patients to break the recurrent disease cycle.

Trends in and Risk Factors for Drug Resistance in Mycobacterium tuberculosis in HIV-Infected Patients.

Trends in and risk factors for drug resistance in Mycobacterium tuberculosis (M. tuberculosis) in human immunodeficiency virus (HIV)-infected patients with active tuberculosis were analyzed. The clinical data of M. tuberculosis and HIV-coinfected patients treated at the Shanghai Public Health Clinical Center between 2010 and 2022 were collected. The diagnosis of tuberculosis was confirmed by solid or liquid culture. The phenotypic drug susceptibility test was carried out via the proportional method, and the resistance to first-line and second-line drugs was analyzed. Logistic regression analysis was performed to identify associated risk factors for drug resistance in M. tuberculosis. Of the 304 patients with a M. tuberculosis-positive culture and first-line drug susceptibility test results, 114 (37.5%) were resistant to at least one first-line anti-tuberculosis drug. Of the 93 patients with first-line and second-line drug susceptibility test results, 40 (43%) were resistant to at least one anti-tuberculosis drug, and 20 (21.5%), 27 (29.0%), 19 (20.4%), 16 (17.2%), and 14 (15.1%) were resistant to rifampicin, streptomycin, ofloxacin, levofloxacin, and moxifloxacin, respectively; 17 patients (18.3%) had multidrug-resistant tuberculosis (MDR-TB). Between 2010 and 2021, the rate of resistance to streptomycin and rifampicin ranged from 14.3% to 40.0% and from 8.0% to 26.3%, respectively, showing an increasing trend year by year. From 2016 to 2021, the rate of resistance to quinolones fluctuated between 7.7% and 27.8%, exhibiting an overall upward trend. Logistic regression analysis showed that being aged <60 years old was a risk factor for streptomycin resistance, mono-drug resistance, and any-drug resistance (RR 4.139, p = 0.023; RR 7.734, p = 0.047; RR 3.733, p = 0.009). Retreatment tuberculosis was a risk factor for resistance to rifampicin, ofloxacin, of levofloxacin (RR 2.984, p = 0.047; RR 4.517, p = 0.038; RR 6.277, p = 0.014). The drug resistance rates of M. tuberculosis to rifampicin and to quinolones in HIV/AIDS patients were high and have been increasing year by year. Age and a history of previous anti-tuberculosis treatment were the main factors associated with the development of drug resistance in HIV/AIDS patients with tuberculosis.

Improving the diagnosis of active tuberculosis: a novel approach using magnetic particle-based chemiluminescence LAM assay

ObjectivesTuberculosis (TB) is a significant global health concern, given its high rates of morbidity and mortality. The diagnosis using urine lipoarabinomannan (LAM) primarily benefits HIV co-infected TB patients with low CD4 counts. The focus of this study was to develop an ultra-sensitive LAM assay intended for diagnosing tuberculosis across a wider spectrum of TB patients.Design & MethodsTo heighten the sensitivity of the LAM assay, we employed high-affinity rabbit monoclonal antibodies and selected a highly sensitive chemiluminescence LAM assay (CLIA-LAM) for development. The clinical diagnostic criteria for active TB (ATB) were used as a control. A two-step sample collection process was implemented, with the cutoff determined initially through a ROC curve. Subsequently, additional clinical samples were utilized for the validation of the assay.ResultsIn the assay validation phase, a total of 87 confirmed active TB patients, 19 latent TB infection (LTBI) patients, and 104 healthy control samples were included. Applying a cutoff of 1.043 (pg/mL), the CLIA-LAM assay demonstrated a sensitivity of 55.2% [95%CI (44.13%~65.85%)], and a specificity of 100% [95%CI (96.52%~100.00%)], validated against clinical diagnostic results using the Mann-Whitney U test. Among 11 hematogenous disseminated TB patients, the positive rate was 81.8%. Importantly, the CLIA-LAM assay consistently yielded negative results in the 19 LTBI patients.ConclusionOverall, the combination of high-affinity antibodies and the CLIA method significantly improved the sensitivity and specificity of the LAM assay. It can be used for the diagnosis of active TB, particularly hematogenous disseminated TB.

Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome in initiating ART among HIV-Infected patients in China-risk factors and management

BackgroundChina is a country burdened with a high incidence of both tuberculosis (TB) and HIV, Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an important early complication in TB and HIV co-infected patients, but data from China are limited. Additionally, as an integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) regimen becomes the first-line treatment, concerns have arisen regarding the potential increase in the incidence of paradoxical TB-IRIS. Nevertheless, the existing data are inconclusive and contradictory.MethodsWe conducted a retrospective study at Chongqing Public Health Clinical Center from January 2018 to December 2021. We collected demographic and clinical data of HIV/TB co-infected patients who initiated ART. We described the patient characteristics, identified predictors for TB-IRIS, and determined clinical outcomes. The Statistical Package for Social Science (SPSS 25) was used to analyse the data. Continuous variables were compared using Student’s t-test or rank sum test. Counting data were compared using the chi-square test or Fisher’s exact test. The variables with statistical significance in the univariate analysis were added to the binary logistic regression. A p-value less than 0.05 was considered statistically significant.ResultsA total of 384 patients co-infected with naive HIV and pulmonary TB (PTB) who were given ATT and ART combination were included. 72 patients (18.8%) developed paradoxical TB-IRIS with a median of 15 (12, 21) days after initiating ART. Baseline age ≤ 40years, CD4 + T-cell counts ≤ 50cells/µL, HIV viral load ≥ 500,000 copies/mL were found to be significantly associated with development of paradoxical TB-IRIS. Mortality rates were similar in the TB-IRIS (n = 5, 6.9%) group and non-TB-IRIS (n = 13, 4.2%) group. Interestingly, CD4+ T-cell counts recovery post-ART was significant higher in the TB-IRIS group when compared to the non-TB-IRIS group at the end of 24 weeks (P = 0.004), as well as at 48 weeks (P = 0.015). In addition, we consider that INSTI- based ART regimen do not increased the risk of Paradoxical TB-IRIS.ConclusionParadoxical TB-IRIS, while often leading to clinical deterioration and hospitalization, is generally manageable. It appears to have a positive impact on the recovery of CD4 + T-cell counts over time. Importantly, our data suggest that INSTI-based ART regimens do not elevate the risk of TB-IRIS. Thus, paradoxical TB-IRIS should not be considered an impediment to initiating ART in adults with advanced immunodeficiency, except in the case of tuberculous meningitis (TBM).

Prevalence of Hepatitis B Co-infection in HIV Patients and their Demographic Parameters in Patients, attending Tertiary Care ART Centre, Jhalawar, Rajasthan, India: A Retrospective Study

Prevalence of Hepatitis B Co-infection in HIV Patients and their Demographic Parameters in Patients, attending Tertiary Care ART Centre, Jhalawar, Rajasthan, India: A Retrospective Study

Drug-resistant pulmonary tuberculosis at Maradi Regional Hospital Center, Niger (2014-2018)

To describe the clinical, therapeutic and evolutionary profile of patients followed for rifampicin-resistant pulmonary tuberculosis (RR-TB) at the Regional Hospital Centre (RHC) of Maradi (Niger) from 2014 to 2018. We conducted a retrospective and descriptive study based on the records of patients followed for Multidrug-resistant tuberculosis (MDR-TB) between January 1, 2014 and June 30, 2018 at the resistant tuberculosis management unit in Maradi (Niger). This unit is located within the RHC of Maradi and has a capacity of 20 beds in 4 wards. It receives patients with tuberculosis resistant to first-line anti-tuberculosis drugs. In this study, patients diagnosed with RR-TB by genotypic (GeneXpert MTB/RIF) or phenotypic (culture) testing were included. We excluded from this study: patients previously treated for more than 1 month with second-line anti-TB drugs; patients with resistance to second-line injectables (SLI) and/or fluoroquinolones (FQ); patients with an electrocardiogram QTc greater than 500 ms (the corrected QT (QTc) estimates the QT interval at a rate of 60 beats per second); cases of atypical mycobacteriosis detected by phenotypic testing.Patients were previously on 2RHZE/4RH prior to the discovery of resistance. The treatment protocol for resistant TB was as follows: 4KmMfxPtoCfzHZE/5MfxCfzZE (The second-line injectable was replaced by Lzd in case of initial or treatment-emergent deafness). HIV co-infected patients received, in addition to anti-tuberculosis drugs, antiretrovirals and cotrimoxazole in preventive doses. A total of 80 patients were included in the present study (70 males and 10 females, mean age 34.4 years with extremes ranging from 18 to 71 years). Patients aged 18-35 years accounted for more than half. Patients with primary treatment failure were the most frequent type (36%) followed by patients with retreatment failure (24%) and patients with retreatment relapse (17%). It should be noted that 77 patients (96%) were previously treated for TB and only 3 patients (4%) were new cases. The majority of patients (70%) had a Body mass index of less than 18 kg/m2. 7.5% of patients were HIV positive, one was diabetic, 52% of the patients had grade 2 radiological lesions. Grade 1 deafness was noted at the beginning of treatment in 3%. A third of patients (36%) were primary treatment failures. The treatment protocol was as follows: 4KmMfxPtoCfzHZE/5MfxCfzZE. Only 1 patient had a positive culture at the end of the 4th month of treatment. Most of the patients had experienced adverse events, mainly digestive, with vomiting being the most common. The therapeutic success rate was 88%. We noted 10% of deaths, 1% of therapeutic failure and 1% of lost to follow-up.Six months after treatment, 48 patients (60%) were smear negative and 43 (54%) were culture negative. In 32 patients (40%), the smear was not performed and culture was not performed in 37. The short treatment regime gives satisfactory results in the absence of resistance to fluoroquinolones, with rare adverse effects. In Niger, further efforts should be made to minimize the delay in diagnosis which is responsible for most deaths during treatment. A centre could usefully be designated to organize "TB consiliums" allowing any practitioner to submit difficult cases of MDR-TB.

Incidence of Hepatocellular Carcinoma in Hepatitis-C Patients Presenting to Lady Reading hospital, Peshawar- A Retrospective Study

Background: Hepatocellular carcinoma (HCC) is a significant complication of hepatitis C virus (HCV) infection, with varying incidence and outcomes based on treatment history and co-infections like HIV. Understanding the risk factors and progression of HCC in hepatitis C patients is crucial for effective disease management. Objective: This study aimed to assess the incidence of HCC in patients with a history of hepatitis C, considering factors such as antiviral treatment and HIV co-infection. Methods: A retrospective study was conducted at Lady Reading Hospital, Peshawar, from March 2022 to July 2023, involving 30 patients with decompensated liver disease or cirrhosis and a history of hepatitis C. Patients were evaluated for demographics, treatment history, PCR status, and HIV co-infection. Data analysis focused on the development of HCC in relation to these variables. Results: The study included 30 patients with a mean age of 61.57 ± 11.11 years, predominantly male (93.3%). Of these, 73.3% tested PCR positive for HCV, while 26.7% were PCR negative. A total of 43.3% had received antiviral treatment, while 56.7% had not. HIV co-infection was present in 13.3% of patients. HCC was observed in 80% of patients overall. Among those treated and PCR negative, 87.5% developed HCC. In contrast, 76.5% of untreated, PCR-positive patients developed HCC. Among HIV co-infected patients, 75% developed HCC. Conclusion: The study indicates a high incidence of HCC among hepatitis C patients, regardless of antiviral treatment status or PCR positivity. HIV co-infection appears to be a significant risk factor for HCC development. These findings highlight the need for continuous monitoring and proactive management of hepatitis C patients, especially those co-infected with HIV.

Demographic and Clinical Risk Factors for Tuberculosis Co-Infection in HIV patients: A Literature Review

Demographic and Clinical Risk Factors for Tuberculosis Co-Infection in HIV patients: A Literature Review

Clinical characteristics and outcomes of COVID-19/HIV co-infected patients at referral unit in Recife, Brazil

Clinical characteristics and outcomes of COVID-19/HIV co-infected patients at referral unit in Recife, Brazil

Time to death and its determinant factors of visceral leishmaniasis with HIV co-infected patients during treatment period admitted at Metema hospital, Metema, Ethiopia: a hospital-based cross-sectional study design

BackgroundVisceral leishmaniasis is caused by the parasites Leishmania donovani spices complex that can spread to internal organs and the disease is fatal with a fatality rate of nearly 100% if left untreated. Visceral Leishmania-HIV (HIV1) coinfection disease is a new clinical form of leishmaniasis very serious disease in the endemic part of the world. It also served as the primary cause of death in the lowlands of Ethiopia with the endemic Humara and Metema that are located near the Sudanese border.MethodsA total of 153 visceral leishmaniases with HIV co-infection secondary data was taken from the medical chart of patients from January 2015 to January 2021 and a hospital-based cross-sectional study design was carried out to retrieve relevant information. The data entered by SPSS and analysed using STATA version 14 and R4.2.1 statistical software packages using a non-parametric Model, semi-parametric Cox proportional hazard survival models at 5% significance level.ResultAmong the total visceral leishmaniasis with HIV co-infected patients 3.27% were females and 96.73% were males, 19 (12.42%) patients died and 134(87.58%) patients were censored. The Cox proportional hazard model result indicates that severe acute malnutrition, baseline CD4+ cell count ≥100, and underweight significantly contributed to the survival time of a patient. Cox proportional hazard model shows that severe acute malnutrition (HR=4.40027, 95% CI= 2.455061 262.7934, P-value=0.007), baseline CD4+cell count ≥100 (HR=0.2714623, 95% CI= 0.0764089 0.9644395, P-value=0.044), and Underweight (HR=4.678169, 95% CI= 1.970097 11.10872, P-value=0.040) significantly contributed to a shorter survival time.ConclusionVisceral leishmaniases with HIV co-infected patients show a large number of deaths occurred in the earlier days of treatment this implies that Visceral leishmaniasis accelerates HIV replication and disease progression death. The researcher suggests that people be aware of the burden posed by those risk factors and knowledgeable about the diseases. So, the researcher recommended that to health workers implement primary health care in those patients and careful consideration of a neglected parasitic disease.

The Analysis of The Effectiveness of Pulmonary Tuberculosis and HIV-Co-TB Treatment Therapies at Sulianti Saroso Infectious Diseases Hospital

Mycobacterium tuberculosis causes Tuberculosis (TB), an infectious disease. The study aims to evaluate DOTS therapy's impact on pulmonary TB and TB-HIV patients. This research used a descriptive qualitative study design with a retrospective descriptive research approach using secondary data for the period June 2017 to July 2020. The analysis uses the Miles and Huberman model. A study of 305 people found that 83% of pulmonary TB cases completed treatment within the initial phase, 64% completed the continuation phase. TB-HIV cases 93% completed treatment within the initial phase, 71% the continuation phase. The combination of OAT and ARV doses was successful in reducing initial smear conversion in pulmonary TB cases. The treatment was evaluated as cure in pulmonary TB cases, complete in pulmonary TB-HIV cases, and had no treatment failure status in both groups. Treatment success in pulmonary TB patients was not significantly related (p-value≥5%) with the type of OAT, type of PMO, gender, and age. Whereas in HIV co-infected pulmonary TB patients, treatment success was significantly related (p-value &lt;5%) with the type of PMO, and not related (p-value≥5%) with the type of OAT, gender, and age.

Multiple imputation using chained equations for missing data in survival models: applied to multidrug-resistant tuberculosis and HIV data.

Missing data are a prevalent problem in almost all types of data analyses, such as survival data analysis. To evaluate the performance of multivariable imputation via chained equations in determining the factors that affect the survival of multidrug-resistant-tuberculosis (MDR-TB) and HIV-coinfected patients in KwaZulu-Natal. Secondary data from 1542 multidrug-resistant tuberculosis patients were used in this study. First, data from patients with some missing observations were deleted from the original data set to obtain the complete case (CC) data set. Second, missing observations in the original data set were imputed 15 times to obtain complete data sets using a multivariable imputation case (MIC). The Cox regression model was fitted to both the CC and MIC data, and the results were compared using the model goodness of fit criteria [likelihood ratio tests, Akaike information criterion (AIC), and Bayesian Information Criterion (BIC)]. The Cox regression model fitted the MIC data set better (likelihood ratio test statistic =76.88 on 10 df with P<0.01, AIC =1040.90, and BIC =1099.65) than the CC data set (likelihood ratio test statistic =42.68 on 10 df with P<0.01, AIC =1186.05 and BIC =1228.47). Variables that were insignificant when the model was fitted to the CC data set became significant when the model was fitted to the MIC data set. Correcting missing data using multiple imputation techniques for the MDR-TB problem is recommended. This approach led to better estimates and more power in the model.

Expert Review on Contemporary Management of Common Benign Pleural Effusions.

Heart failure (HF) and cirrhosis are frequently associated with pleural effusions (PEs). Despite their apparently benign nature, both HF-related effusions and hepatic hydrothorax (HH) have poor prognosis because they represent an advanced stage of the disease. Optimization of medical therapy in these two entities involve not only the use of diuretics, but also other pharmacological therapies. For instance, all HF patients with reduced or mildly reduced left ventricular ejection fraction can benefit from angiotensin receptor-neprilysin inhibitors, beta blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors. Conversely, it is better for HH patients to avoid nonselective beta blockers. Refractory cardiac- and cirrhosis-related PEs are commonly managed by iterative therapeutic thoracentesis. When repeated aspirations are needed, thereby diminishing quality of life, the insertion of an indwelling pleural catheter (IPC) may be warranted. However, in selected HH patients who are diuretic-resistant or diuretic-intractable, placement of transjugular intrahepatic portosystemic shunts should be considered as a bridge to liver transplantation, whereas in transplant candidates the role of IPC is debatable. Another benign condition, pleural tuberculosis (TB) is a serious health problem in developing countries. Diagnostic certainty is still a concern due to the paucibacillary nature of the infection, although the use of more sensitive nucleic acid amplification tests is becoming more widespread. Its treatment is the same as that of pulmonary TB, but the potential drug interactions between antiretroviral and anti-TB drugs in HIV-coinfected patients as well as the current recommended guidelines for the different types of anti-TB drugs resistance should be followed.

Resistant Tuberculosis in HIV-Positive Patients: A Growing Public Health Threat

<i>Introduction: </i>Tuberculosis (TB) is a pathology considered one of the main causes of death by single infectious agent, ranking just after HIV / AIDS. Indeed, its emergence and the difficulty of its treatment, especially in the resistant form, in patients with co-infection with other diseases immundéprimante as HIV.<i> Observation 1:</i> 31 years old presented with febrile headaches complicated by epileptic seizures. The MRI scan showed 3 cockeyed and multilocular lesions suggesting neuromeningeal tuberculosis. HIV serology came back positive and during the first line treatment he relapsed and the resistance test was positive.<i> Observation 2:</i> 45 progressive alteration of the state associated with signs of tuberculosis impregnation and a meningeal syndrome. BK in the CSF and in the sputum was positive and brain imaging allowed us to retain the diagnosis of a neuromeningeal tuberculosis. The patient was put on anti-bacillary ERIP k4 and a corticotherapy. The workup for co-infection was able to establish an HIV infection. After 3 weeks of anti-bacillary treatment, the patient had a bad evolution and the search for resistance came back positive. <i>Observation 3: </i>25 years old, pulmonary tuberculosis manifested by a hemoptysis of small abundance associated with a deep alteration of the general state, 3 BK positive sputum, as well as the image of a tuberculous cavern on the thoracic CT. Bad evolution after 2 months of treatment of first worsening of symptoms neuro and systemic involvement the search for resistance came back positive. <i>Discussion:</i> Drug-resistant tuberculosis is a major global public health challenge. In this article, we present three cases of drug-resistant TB in HIV-coinfected patients, highlighting the emergence and increasing prevalence of multidrug-resistant TB (MDR-TB) strains worldwide. In order to control the spread of this dreaded disease, it is essential to improve treatment regimens, promote vaccination, educate affected patients, and promote adherence to treatment. <i>conclusion: </i>Diagnosis of drug-resistant tuberculosis should be prompt and considered if there is a delay or lack of improvement with conventional tuberculosis treatment.

EVALUATING THE RISK FACTORS AFFECTING THE SURVIVAL TIME OF TB/HIV CO-INFECTED PATIENTS TO EARLY DEATH AT RASHID SHEKONI TEACHING HOSPITAL, JIGAWA STATE

Tuberculosis is a serious health threat, especially for people living with HIV. people living with HIV are more likely than others to become sick with TB. Worldwide TB is one of the leading courses of death among people living with HIV (CDC 2015). A retrospective cohort study was conducted in which all patients registered for TB/HIV at Rashid shekoni teaching hospital from 1st January 2017 to 31st December 2021. Kaplan Meier and log rank test were used to determine the survival pattern and the survival experience of two or more different groups. Cox regression was used to identify factors affecting the survival time of the patients. This study consists of 274 TB and HIV co-infected adult patient out of these 120 were died during the study period, and 154 were censored.it was found that massive death occurred at 1.3years of follow up period and the over roll median survival time was (56 months). the multivariate cox regression analysis indicated that an old age patient&gt;39yrs, HIV+, low CD4 cell count&lt;456, weight&lt;42 were significant risk factors associated with death of TB/HIV co-infected patients. In this study the death of TB/HIV adult co-infection was found to be very high at 1.3yr. The risk factors leading to early death of TB/HIV co-infection was associated with age, weight, HIV+ positive, CD4 cell count. The medical decision and policy makers should give these risk factors identified in this study more priority when implementing target improvement in the National TB and HIV program.

Effect of HCV treatment with DAAs on serum intestinal fatty acid binding protein (I-FABP) as a marker of intestinal permeability in HCV/HIV co-infected patients

BackgroundHCV and HIV co-infected patients develop cirrhosis more rapidly than HCV mono-infection. Intestinal injury and microbial translocation are postulated mechanisms for the rapid progression of cirrhosis.AimStudy the effect of HCV treatment with DAAs on serum intestinal fatty acid binding protein (I-FABP) as a marker of intestinal injury in HCV/HIV co-infected patients and its relation to hepatic fibrosis. Comparing the level of I-FABP in HCV mono-infection and HCV/HIV co-infection was a secondary aim.MethodsI-FABP levels were measured in 50 non-cirrhotic HCV/HIV co-infected patients pre- and post-HCV treatment (SVR 12) (25 patients were HIV treatment naive, and 25 patients were on HAART) and in 25 chronic HCV patients as a control group. Hepatic fibrosis was assessed by FIB4 score, APRI score, and transient elastography.ResultsHCV/HIV co-infected patients had significantly higher levels of I-FABP compared to the HCV-mono-infected patients (P = 0.001). After HCV treatment in HCV/HIV co-infected patients, I-FABP level was significantly elevated (P < 0.001) and was positively correlated with baseline FIB4 values and serum ALT levels (r = 0.283, P-value = 0.047) and (r = 0.340, P-value = 0.016), respectively.ConclusionHCV/HIV co-infection is associated with significantly higher intestinal injury and subsequent hepatic fibrosis than HCV mono-infection. HIV infection is associated with intestinal epithelial injury and microbial translocation and may play a role in the persistence of systemic inflammation after HCV eradication.

Association of Hospitalization Rate, Mortality, and CD4 T Cell Count with Comorbidity of COVID-19 and HIV: A Systematic Review and Meta-Analysis.

Epidemiological data demonstrate the greater severity of SARS-CoV-2 infection in HIV patients along with the more hospitalization, and mortality rates. Thus, this meta-analysis aimed to assess the possible differences in hospitalization, mortality, and the CD4 T cell counts between COVID-19/HIV co-infected patients and the control group. The relevant studies were obtained from online databases such as Science Direct, PubMed, Scopus, Web of Science, and Google Scholar using Mesh and Non-Mesh keywords and the meta-analysis was conducted according to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols checklist. Then, the Newcastle-Ottawa scale (NOS) checklist was used to assess the quality of selected studies. According to the random effect models, the odds ratios of hospitalization, mortality, and CD4 T cell counts were estimated. The odds ratios of hospitalization and mortality rates in COVID-19 patients with HIV were 1.67 (confidence interval [CI]: 0.76 to 3.71) and 0.80 (CI: 0.57 to 1.11), respectively, compared to that of the COVID-19 group. In this meta-analysis, there was no statistically significant difference in the rates of hospitalization, mortality, and CD4 T cell counts between COVID-19 patients with HIV and the control group. The similarity between the studied groups could be attributed to factors such as the rarity of COVID-19/HIV co-infection patients and the presence of random error, administration of antiretroviral therapy in HIV patients, and early hospitalization time in COVID-19/HIV co-infected patients.

The Relationship between Neutrophil Lymphocyte Ratio and Hepatitis C Virus RNA in Hepatitis C Coinfected HIV Patients Receiving Direct-Acting Antiviral Therapy at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Background: Hepatitis C is an inflammatory disease of the liver caused by infection with the hepatitis C virus (HCV). Inflammatory markers are significant in assessing the course of an infectious or inflammatory disease. One of them is the neutrophil-lymphocyte ratio (NLR) and the amount of HCV RNA viral load, which combines neutrophils as an active inflammatory component and lymphocytes as a regulatory and protective component in a single parameter. Research on the relationship between NLR and HCV RNA in HIV patients coinfected with HCV is still limited. This study aimed to determine the relationship between NLR and HCV RNA in HIV-HCV coinfected patients who received DAA therapy and went to the outpatient polyclinic at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.&#x0D; Methods: Analytic observational study. A total of 38 research subjects participated in this study. Observation of NLR was carried out using hematology analyzer, and observation of HCV RNA levels was carried out using the PCR technique. Data analysis was carried out using SPSS univariate and bivariate.&#x0D; Results: There was a difference between pre-post therapy NLR and pre-post therapy HCV RNA viral load, p&lt;0.05. NLR is in line with HCV RNA viral load as a prognostic tool for successful DAA therapy in HIV patients coinfected with hepatitis C.&#x0D; Conclusion: There is a relationship between HIV and HCV RNA in hepatitis C coinfected HIV patients receiving direct-acting antiviral therapy at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.