HIV-infected Adults Research Articles

A qualitative study of the stigmatization and coping mechanisms among pregnant teenagers living with HIV in Thailand

PurposeThis aim of this study was to explore the experiences of stigmatization and coping mechanisms during pregnancy among pregnant women who are living with HIV in Thailand. The secondary objective was to determine factors contributing to stigma during motherhood among HIV-infected women as well as explore how they cope with the discrimination from society.Design/methodology/approachQualitative data were collected using in-depth interviews to obtain different versions of stigmatized experience from 16 pregnant women living with HIV on stigmatization and coping mechanisms. There were 5 pregnant adolescents living with HIV and 11 adult pregnant women living with HIV. The content analysis was used to examine patterns of stigmatizations and attributed factors.FindingsPersonal stigma was found among pregnant women living with HIV regardless of age. HIV status disclosure was the crucial barrier of accessing to care for people experiencing stigmatizations. Personal stigma associated with higher HIV status was not disclosed. Interestingly, all teenage mothers who participated in this study disclosed their HIV-status to their family. People who have social support especially from family and significant others are found to be able to cope and get through the difficulties better than those who lack those social support.Originality/valueThis study yields outcomes similar to several other studies that have been conducted either in Thailand or other countries. This study found that family support was crucial in reducing HIV stigma. Furthermore, HIV-infected pregnant female adults were more afraid to disclose their HIV status to their husbands, other family members and their work colleagues.

Derangement of protein S and C4b-binding proteinlevels as acquired thrombophilia in HIV-infected adult Nigerians.

BackgroundHIV is a chronic inflammatory state with the production of many acute-phase-reactant proteins. Some of these proteins have procoagulant activities that predispose HIV-infected patients to thrombosis.ObjectivesThe aim of the study was to evaluate the effects of HIV infection on the serum levels of C4b-binding protein (C4BP) and protein S as markers of predisposition to thrombosis in HIV-infected adults.MethodsThe study population comprised of 61 HIV-infected adults on antiretroviral treatment (ART) who had achieved virological suppression, 58 HIV-infected adults not yet on ART and 59 HIV-negative healthy controls. The serum levels of free protein S, C4BP and the euglobulin clot lysis time (ECLT) were determined.ResultsThe mean plasma-free protein S level of HIV-infected patients on ART (86.9% ± 25.8%) was significantly higher than that of treatment-naïve HIV-infected patients (75.7% ± 27.3%) (p = 0.005). Conversely, there was no statistically significant difference between the protein S levels of the HIV-infected subjects on ART (86.9% ± 25.8%) and those of the controls (94.9% ± 7.9%) (p = 0.119). The mean C4BP was significantly higher in the treatment-naïve HIV-infected subjects (36.7 ± 1.7 ng/dL) than that in those on ART (30.7 ± 2.6 ng/dL) and that in the controls (22.4 ± 2.4 ng/dL) (p < 0.0001). Protein S deficiency was more prevalent among the subjects with elevated C4BP (p = 0.023). The mean ECLT was significantly more prolonged in the treatment-naïve HIV-infected subjects (241.9 ± 34.7 s) than controls (189.5 ± 40.7 s) (p < 0.0001).ConclusionHIV infection causes elevated levels of C4BP and diminishes the serum levels of free protein S. We infer that the risk of thrombosis (as measured by these biomarkers) decreases with the use of antiretroviral drugs.

Determinants of Utilization of Early Infant HIV Diagnosis Services at Kericho County Referral Hospital, Kericho County, Kenya

HIV and AIDS has become a health challenge globally. It is a major cause of infant and childhood morbidity and mortality in Africa. This research was a cross sectional analytical survey to assess the determinants of utilization of Early Infant Diagnosis (EID) at Kericho County Referral Hospital (KCRH). Data was collected using pretested questionnaires, administered to the postnatal HIV positive mothers and or caretakers of HIV exposed children. Data was analysed using SPSS software version 18.0. Data was analysed using Chi-square and Logistic Regression analysis. Of the 254 respondents, 201 (79.1%) were biological mothers to the children, the rest were caretakers. The children were aged between 1 and 18 months with a mean age of 9.62 months. Majority of the respondents had adequate knowledge of adult HIV infection with regard to what HIV is, routes of transmission, diagnosis and treatment. Knowledge of paediatric HIV infection was however inadequate with only 132 (52%) respondents who knew the approximate rate of HIV transmission from mother to child and 130 (51.2%) who knew about the availability of paediatric Antiretroviral (ARV) drugs. Both adult and paediatric HIV knowledge was better with increasing level of education. The younger respondents were also more knowledgeable than the older ones. The children who had utilized EID were only 75 (29.5%). The significant determinants of EID utilization included: the level of education (p=0.002), the place of delivery (p&lt;0.01), the age of the respondent (p=0.008), the distance to the nearest healthcare facility that offered EID (p=0.004) among others. The most significant determinants of EID utilization were the level of education, accessibility and the age of the respondents. In conclusion, EID utilization is still low in Kericho County. This study recommends that improving maternal education would improve EID uptake.

Stratifying Sepsis in Uganda Using Rapid Pathogen Diagnostics and Clinical Data: A Prospective Cohort Study.

The global burden of sepsis is concentrated in sub-Saharan Africa, where extensive pathogen diversity and limited laboratory capacity challenge targeted antimicrobial management of life-threatening infections. In this context, established and emerging rapid pathogen diagnostics may stratify sepsis patients into subgroups with prognostic and therapeutic relevance. In a prospective cohort of adults (age ≥18 years) hospitalized with suspected sepsis in Uganda, we stratified patients using rapid diagnostics for HIV, tuberculosis (TB), malaria, and influenza, and compared clinical characteristics and 30-day outcomes across these pathogen-driven subgroups. From April 2017 to August 2019, 301 adults were enrolled (median age, 32 years [interquartile range, 26-42 years]; female, n = 178 [59%]). A total of 157 patients (53%) were HIV infected. Sixty-one patients (20%) tested positive for malaria, 52 (17%), for TB (including 49 of 157 [31%] HIV-infected patients), and 17 (6%), for influenza. Co-infection was identified in 33 (11%) patients. The frequency of multi-organ failure, including shock and acute respiratory failure, was greatest among patients with HIV-associated TB. Mortality at 30 days was 19% among patients with malaria, 40% among patients with HIV-associated TB, 32% among HIV-infected patients without microbiological evidence of TB, 6% among patients with influenza, and 11% among patients without a pathogen identified. Despite improvements in anti-retroviral delivery, the burden of sepsis in Uganda remains concentrated among young, HIV-infected adults, with a high incidence of severe HIV-associated TB. In parallel with improvements in acute-care capacity, use of rapid pathogen diagnostics may enhance triage and antimicrobial management during emergency care for sepsis in sub-Saharan Africa, and could be used to enrich study populations when trialing pathogen-specific treatment strategies in the region.

Maternal and caretaker's knowledge of HIV infections and the existence and benefits of early infant diagnosis (EID) services at Kericho county referral hospital, Kenya.

This study was a cross-sectional analytical survey of the Maternal and caretaker's knowledge of HIV infections and the existence and benefits of early infant diagnosis (EID) services at Kericho county referral hospital in Kenya. Data was collected using pretested questionnaires administered to the postnatal HIV positive mothers and or caretakers of HIV exposed children. Data were analysed using SPSS software version 18.0. Moreover, it was presented using Chi-square and Logistic Regression analysis. Of the 254 respondents, 201 (79.1%) were biological mothers to the children; the rest were caretakers. The children were aged between 1 and 18 months, with a mean age of 9.62 months. Most respondents' knowledge of adult HIV infection is about what HIV is, routes of transmission, diagnosis and treatment. Knowledge of paediatric HIV infection was, however, inadequate with only 132 (52%) respondents who knew the approximate rate of HIV transmission from mother to child and 130 (51.2%) who knew about the availability of paediatric Antiretroviral (ARV) drugs. Both adult and paediatric HIV knowledge was better with an increasing level of education. The younger respondents were also more knowledgeable than, the older ones. Children who had utilised EID were only 75 (29.5%). In conclusion, EID knowledge is still lacking in Kericho County, and it influences the utilisation of these services. EID services and education on the availability should be decentralised where feasible. They should be included as an essential service at all levels of healthcare delivery to reach more children. Further research needs to be done on how to leverage HIV knowledge to increase the uptake of services and alleviate impediments to utilising services. Improving maternal education is strongly recommended, as it would enhance EID uptake.

Feasibility of Rapid Case Ascertainment for Cancer in East Africa: An Investigation of Community-Representative Kaposi Sarcoma in the Era of Antiretroviral Therapy

BackgroundRapid case ascertainment (RCA) refers to the expeditious and detailed examination of patients with a potentially rapidly fatal disease shortly after diagnosis. RCA is frequently performed in resource-rich settings to facilitate cancer research. Despite its utility, RCA is rarely implemented in resource-limited settings and has not been performed for malignancies. One cancer and context that would benefit from RCA in a resource-limited setting is HIV-related Kaposi sarcoma (KS) in sub-Saharan Africa. MethodsTo determine the feasibility of RCA for KS, we searched for all potential newly diagnosed KS among HIV-infected adults attending three community-based facilities in Uganda and Kenya. Searching involved querying of electronic medical records, pathology record review, and notification by clinicians. Upon identification, a team verified eligibility and attempted to locate patients to perform RCA, which included epidemiologic, clinical and laboratory measurements. ResultsWe identified 593 patients with suspected new KS. Of the 593, 171 were ineligible, mainly because biopsy failed to confirm KS (65%) or KS was not new (30%). Among the 422 remaining, RCA was performed within 1 month for 56% of patients and within 3 months for 65% (95% confidence interval: 59 to 70%). Reasons for not performing RCA included intervening death (47%), inability to contact (44%), refusal/unsuitable to consent (8.3%), and patient re-location (0.7%). ConclusionsWe found that RCA ― an important tool for cancer research in resource-rich settings ― is feasible for the investigation of community-representative KS in East Africa. Feasibility of RCA for KS suggests feasibility for other cancers in Africa.

Comparative Efficacy of Antifungal Agents Used in the Treatment of Oropharyngeal Candidiasis among HIV-Infected Adults: A Systematic Review and Network Meta-Analysis.

The objective of this study was to assess the comparative efficacy and safety of different antifungal agents used for the treatment of oropharyngeal candidiasis (OPC) in adult patients with HIV. A systematic search was performed on the four major databases (Medline, Embase, CENTRAL and Scopus) to identify randomized controlled trials (RCTs) that evaluated the efficacy of antifungal agents in HIV patients with OPC. A network meta-analysis was performed from the data extracted from the selected studies. The agents were ranked according using surface under the cumulative ranking (SUCRA). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to determine the quality of evidence. A total of 15 trials were included in the quantitative analysis involving the data from a total of 2883 participants. Fluconazole was ranked as the most effective antifungal agent to achieve clinical cure (SUCRA = 0.87) in OPC followed by posaconazole and itraconazole. Posaconazole was ranked the most efficacious agent in achieving mycological cure (SUCRA = 0.81), followed by fluconazole. While nystatin was ranked the safest, the effect estimates of none of the other systemic antifungal agents were significantly higher than fluconazole. Based on the available evidence, fluconazole can be considered as the most effective drug in the treatment of OPC among HIV-infected adults and has a favorable safety profile, followed by posaconazole.

Subclinical atherosclerosis and immune activation in young HIV-infected patients with telomere shortening.

Background: To date, available data on premature aging in young HIV-infected adults are scarce and no reports offer comprehensive assessment of telomere shortening (TS) in relation to subclinical atherosclerosis (SCA). In this study, we investigate if telomere shortening and immune activation markers are associated with SCA, which is one of the main degenerative diseases in young HIV-infected adults.Methods: A descriptive cross-sectional study was carried out in 149 HIV-infected patients on stable antiretroviral regimen (ART). Carotid intima-media thickness (cIMT) was estimated by carotid ultrasound. Quantitative singleplex PCR was performed to evaluate TS. The expression of activation/senescence markers was evaluated by multiparametric flow cytometry.Results: TS was observed in 73 patients (49%). Higher cIMT was observed in patients with TS than those without it (0.86 vs. 0.80 mm; p=0.041). Patients under the age of 50 (defined as young adults) with TS showed higher absolute numbers of activated lymphocyte T cells CD8+CD38+ (3.94 vs. 2.34 cell/μl; p=0.07) and lymphocyte B cells CD19+CD38+ (3.07 vs. 2.10 cell/μl; p=0.004) compared to those without TS. In the multivariate analysis, the only factor independently associated with TS was the absolute number of lymphocyte T cells CD8+CD38+ T cells (OR = 1.18; 95%-CI = 1.00-1.39; p = 0.05).Conclusion: Young HIV-infected adults show premature biological aging with accentuated immune activation. Chronic inflammation with excessive T-cells activation could be associated to TS, premature aging, and SCA in young HIV-infected adults.

Effectiveness of screening for tuberculosis in HIV: a pragmatic clinical trial

ABSTRACTOBJECTIVE:To verify the effectiveness of screening for tuberculosis (TB) on all-cause mortality and tuberculosis cases in newly diagnosed HIV-infected patients through a clinical algorithm based on recommendations of the World Health Organization.METHODS:From March 2014 to April 2016, a pragmatic randomized clinical trial was conducted with newly diagnosed and TB-free HIV-infected adults undergoing antiretroviral therapy for up to one month at a major tertiary hospital for HIV in the state of Pernambuco, Brazil. Participants were randomized into intervention and control groups using an automatically-generated random list, and followed-up for at least 6 months. The intervention group was screened for TB at hospital admission and at every follow-up visit through a series of questions addressing TB-related symptoms (cough, fever, night sweating, and weight loss). Patients presenting with any of these symptoms were referred to a pulmonologist and underwent sputum smear microscopy, sputum culture, and rapid molecular testing (GeneXpert). When at least one test result came back positive, TB treatment was initiated. In turn, if patients tested negative but presented with severe clinal symptoms, TB preventive treatment was initiated. Screening for TB was not performed systematically in the control group. The primary outcome assessed in this study was death from all causes, and secondary outcomes included sensitivity and specificity of this screening test, as well as its detection time.RESULTS:This study evaluated 581 patients, 377 in the intervention group (64.9%) and 204 in the control group (35.1%). In total, 36 patients died during the follow-up period. Of these, 26 (6.9%) were from the intervention group, reaching a cumulative mortality coefficient of 69 per 1,000 inhabitants, and 10 (4.9%) from the control group (p = 0.341), with a cumulative mortality coefficient of 49 per 1,000 inhabitants (p = 0.341).

Differential diagnosis of chronic diarrhea in patients with HIV infection

Today, when the whole world is overwhelmed by the coronavirus pandemic, few people remember that it was AIDS that was called the plague of the twentieth century. The manifestations of the acquired immunodeficiency syndrome are the terminal stage of infection of the body with the human immunodeficiency virus, which belongs to retroviruses and leads to the development of secondary immunodeficiency. The first case of HIV infection in adults was described in 1981 in America. A young homosexual came to one of the hospitals in the city of San Francisco with a persistent fungal infection. Some time after the treatment, the young man developed pneumonia, from the complications of which he soon died. The human immunodeficiency virus got its name only in 1982, and the disease caused by it began to be called the acquired immunodeficiency syndrome. At present, there are more than 40 million infected people in the world, 2/3 of whom live in Africa; in total, since the beginning of the epidemic, almost 100 million people have been infected with HIV, and the number of victims has doubled the number of people who died in the First World War. Despite the fact that this infection is not airborne or transmitted by contact, the growth rate of this disease continues to shock. Thus, about 5 thousand people get infected with HIV every day in the world; annually about 1 million die from complications of this disease. It should be noted that only 71% of those infected are aware of their status, all the rest continue to serve as a potential source of the spread of this terrible infection.

Depression and HIV associated neurocognitive disorders among HIV infected adults in rural southwestern Uganda: a cross-sectional quantitative study

BackgroundHIV-Associated Neurocognitive Disorder (HAND remains a pronounced consequence of HIV/AIDS despite improved life expectancies. This is often associated with several dysfunctions such as decrease of attention, mood alterations and psychomotor disturbances. Many factors, including age, gender, employment status, and psychiatric disorders, have been associated with HAND. Among the associated psychiatric disorders, depression is often more prevalent. It can influence not only quality of life, relationships and employment but also adherence to medical care. We assessed the prevalence of depression and its association with HAND among people living with HIV in rural Southwestern Uganda.MethodsThis was a cross-sectional study that used Beck Depression Inventory-1 and International HIV Dementia Scale to assess depression and HAND respectively. We defined depression with a score of > 10 and HAND with a cutoff score of ≤10. We conducted data analysis using STATA version 12, and Pearson Chi-square test and logistic regression to determine associations between depression and HAND. The level of statistical significance was set at p ≤ 0.05. Ethical approval and administrative clearance were obtained from relevant bodies.ResultsOf the 393 participants assessed for depression and HAND, 27% had depression and 58.3% screened positive for HAND. All levels of depression were more prevalent among female participants. We found a significant association between depression and HIV associated neurocognitive disorders (χ2 (3) = 9.0538 p = 0.029).ConclusionOur findings confirmed a high prevalence of depression in individuals with HAND which is a major component of the disease burden.

Influence of SULT1A1*2 Polymorphism on Plasma Efavirenz Concentration in Thai HIV-1 Patients.

PurposePlasma efavirenz (EFV) concentrations within therapeutic levels are essential to successfully treat patients suffering from human immunodeficiency virus (HIV) type 1. In addition to the drug-metabolizing enzyme CYP2B6, other phase II drug-metabolizing enzymes and transporters may have an important role in the pharmacokinetics of EFV. Thus, the influence of phase II drug-metabolizing enzymes and drug transporters on plasma EFV levels was investigated in Thai HIV patients receiving EFV.Patients and MethodsGenotyping was performed by TaqMan® real-time PCR in 149 HIV-infected Thai adults, and plasma efavirenz concentration was measured by a validated high-performance liquid chromatography in 12 hours after dosing steady-state plasma samples at week 12 and 24.ResultsPatients with three or more copies of SULT1A1 had significantly lower median plasma EFV concentrations than those carrying two copies at week 12 (p=0.046) and SULT1A1*2 (c.638G>A) carriers had significantly lower median plasma EFV concentrations compared to those not carrying the variant at week 24 (p=0.048). However, no significant association was found after adjusting for CYP2B6 genotype.ConclusionGenetic variation in a combination of SULT1A1*2 and SULT1A1 copy number may contribute to variability in EFV metabolism and thereby may impact drug response. The influence of a combination between the SULT1A1 and CYP2B6 genotype on EFV pharmacokinetics should be further investigated in a larger study population.

Abstract 32: Characteristics of Hepatocellular Carcinoma in Nigerians with and without HIV

Abstract Purpose: Hepatocellular carcinoma (HCC) is a major public health problem in West African countries. HCC still has a strikingly high mortality in this region. Whether HIV also contributes to an increased risk of HCC is in this region is unclear. In this study we describe clinical, radiological and laboratory features as well as survival in Nigerians with HCC, with and without HIV infection, enrolled in an NCI-funded study. Methods: This was a prospective, non-interventional study conducted at two Nigerian tertiary hospitals [Jos University Teaching Hospital and Lagos University Teaching Hospital. Subjects&amp;gt;18 years with HCC diagnosed according to AASLD criteria were included. Results: 204 participants were included in this study [males 144 (71%), median age 50 yrs (IQR 19, 86); HIV-infected (25 (12%)]. 51(27.6%) of all subjects were anti-HCV positive [HIV-uninfected 46 (28.4%) vs. HIV-infected 5(21.7%); p=0.62]. 62% of anti-HCV positive patients at JUTH were confirmed to have active infection (HCV RNA&amp;gt;10IU/mL). Median CD4 T cell count among HIV-infected was 236.50 [61.00-479.00] cells/mm3. 72% of the HIV patients were on ART. Tumor mass diameter on computed tomography did not differ between subject groups [HIV-infected 6.5cm (1.80-80.00) vs. HIV-uninfected 8.9 cm (1-93.0); p=0.23). Overall median survival for both groups was 2.04 months CI (1.58, 4.47). The mean probability of survival at month 1 was 0.7 (95% CI, 0.6, 0.8). Conclusion: A very short median survival was observed in this cohort of HIV-infected and uninfected Nigerian adults with HCC. Almost a third of all subjects were anti-HCV positive and two thirds of these subjects had active infection suggesting HCV infection is an important, risk factor for HCC in this setting. Citation Format: Pantong Davwar, Emoubor Odeghe, Mary Duguru, Ganiat Oyeleke, David Nyam, Edith Okeke, Olufunmi Lesi, Kwang-youn Kim, Godwin Imade, Alani Akanmu, Atiene Sagay, Lewis Robert, Lifang Hou, Rob Murphy, Claudia Hawkins. Characteristics of Hepatocellular Carcinoma in Nigerians with and without HIV [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 32.

Cost-Effectiveness of Amphotericin B Deoxycholate Versus Itraconazole for Induction Therapy of Talaromycosis in Human Immunodeficiency Virus-Infected Adults in Vietnam.

BackgroundTalaromycosis (penicilliosis) is an invasive fungal infection and a major cause of human immunodeficiency virus (HIV)–related deaths in Southeast Asia. Guidelines recommend induction therapy with amphotericin B deoxycholate; however, treatment with itraconazole has fewer toxic effects, is easier to administer, and is less expensive. Our recent randomized controlled trial in Vietnam found that amphotericin B was superior to itraconazole with respect to 6-month mortality. We undertook an economic evaluation alongside this trial to determine whether the more effective treatment is cost-effective.MethodsResource use, direct and indirect costs, and health and quality-of-life outcomes (measured using quality-adjusted life-years [QALYs]) were evaluated for 405 trial participants from 2012 to 2016. Both a Vietnamese health service and a broader societal costing perspective were considered. Mean costs and QALYs were combined to calculate the within-trial cost-effectiveness of amphotericin vs itraconazole from both perspectives.ResultsFrom a Vietnamese health service perspective, amphotericin increases costs but improves health outcomes compared to itraconazole, at a cost of $3013/QALY gained. The probability that amphotericin is cost-effective at a conventional (World Health Organization CHOICE) threshold of value for money is 46%. From a societal perspective, amphotericin is cost-reducing and improves outcomes compared to itraconazole, and is likely to be a cost-effective strategy at any value for money threshold greater than $0.ConclusionsOur analysis indicates that induction therapy with amphotericin is a cost-effective treatment strategy for HIV-infected adults diagnosed with talaromycosis in Vietnam. These results provide the evidence base for health care providers and policy makers to improve access to and use of amphotericin.

Ocular manifestations and refractive errors among people living with HIV in Pune, India: a cross-sectional study.

ObjectiveWe aimed to determine the ocular manifestation and refractive error prevalences among people living with HIV (PLHIV) in Pune, India.MethodsThis cross-sectional study included HIV-infected adults attending a National AIDS Research Institute clinic. Ophthalmologic examination included visual acuity estimation, refraction, orthoptic evaluation, slit lamp and fundus examination, and photography.ResultsIn total, 441 HIV-infected individuals were enrolled. The participants' median age was 44 (interquartile range 38–49) years and 227 (51.5%) were men. Refractive errors occurred in 132 (29.9%) individuals. Ocular manifestations were present in 93 (21.1%) participants and the most frequent was cataract in 59 (13.4%) participants. Multivariate logistic regression analysis showed that participants who were illiterate (adjusted odds ratio [AOR] 2.80, 95% confidence interval [CI] 1.47–5.33) and those aged greater than 40 years (AOR 5.59, 95% CI 2.69–11.61) were more likely to have ocular manifestations. The odds of having ocular manifestations were greater in participants with treatment substitution or changes (AOR 2.11, 95% CI 1.16–3.82).ConclusionsCataract and refractive errors were prevalent among PLHIV. PLHIV should be encouraged to have regular ophthalmic checkups. Individuals with lower education levels and older age should be counseled regarding eye care and timely reporting of ocular symptoms.

Health-Related Quality of Life of HIV Infected Persons on Antiretroviral Therapy in Jos, Plateau State Nigeria

Context: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) remains an important global health problem. People living with HIV (PLHIV) experienced physical, social and mental health challenges that can affect their quality of life (QOL). Aim: To determine the health-related quality of life (HRQOL) of HIV-infected adults. Settings and design: This was a cross-sectional study conducted in the APIN centre. One hundred and seventy-eight PLHIV were selected by a multistage sampling technique between 10 January 2018 and 31 March 2018. Materials and Methods: The world Health Organization QOL-HIV Bref Questionnaire was used to collect the information. Statistical analysis used: Data were analysed using SPSS version 23.0 statistical software We determined significant factors using Chi square and logistic regression at a 5% level of significance. Results: The physical domain has the lowest mean score of 13.25 ± 2.25, while the spiritual/religion/personal belief domain had the highest mean score of 14.955 ± 3.336. Clustered of differentiation 4 (CD4) count, adherence and currently ill status were significantly associated with QOL. The odds for good QOL were 13 times higher among those with CD4 count ≥500 cells/mm3 compared to those with CD4 count &lt; 500 cells/mm3 (adjusted odds ratio [aOR]: 13.03; 95% confidence interval [CI]: 4.58-37.5). The odds for good HRQOL were six times higher among those with good adherence compared to those with poor adherence (aOR: 5.62;95%CI: 1.83-17.26). Conclusion: The study revealed that the spiritual/religion/personal belief domain has the highest QOL score, while the physical domain had the least score. Adherence, currently ill and CD4 count were predictors of good QOL.

Spinal toxoplasmosis in a young man with undiagnosed HIV infection

Spinal cord lesions are potentially devastating conditions leading to reduced mobility, loss of functional independence, and even ventilator dependence, dictated by the level of injury. Tissue diagnosis is paramount to differentiate between primary brain tumours such as ependymomas and glioblastomas, infarction, infection and demyelination. We present the case of a 30-year-old gentleman with subacute neck pain, nausea and evolving right upper limb weakness and paraesthesiae. MRI-spine demonstrated an intramedullary cervical spine mass with associated oedema, thought to represent an ependymoma. Open tissue biopsy revealed numerous bradyzoites on haematoxylin & eosin staining, subsequently confirmed by directed polymerase chain reaction testing as Toxoplasma gondii. Detailed immunological work-up led to a diagnosis of HIV infection, with detection of HIV antibodies and HIV-1 p24 antigen, an HIV-1 viraemia (log 6.33 copies/mL) and low CD4 count (16 cells/mL). Toxoplasmosis is the most common central nervous system infection in HIV patients not receiving appropriate prophylaxis.1 It may occur in up to 30% of such patients who are seropositive for Toxoplasma gondii,2 typically manifesting when CD4+ counts fall below 100 cells/mm3.3 This case highlights the importance of close collaboration between histopathology, microbiology and infectious diseases specialists in diagnosis of a spinal cord infection with associated HIV infection. 1.Porter SB, Sande MA. Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome. N Engl J Med 1992; 327: 1643–8.2.Grant IH, Gold JW, Rosenblum M, et al. Toxoplasma gondii serology in HIV-infected patients: the development of central nervous system toxoplasmosis in AIDS. AIDS 1990; 4: 519–21.3.Kaplan JE, Benson C, Holmes KK, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents. MMWR Recomm Rep 2009; 58: 1–207.

Evaluation of the BioFire® FilmArray® Meningitis/Encephalitis panel in an adult and pediatric Ugandan population

BackgroundMeningitis causes significant mortality in sub-Saharan Africa and limited diagnostics exist. We evaluated the utility of the BioFire® FilmArray® Meningitis/Encephalitis multiplex PCR panel (BioFire ME) in HIV-infected adults and HIV-infected and uninfected children presenting with suspected meningitis in Uganda. MethodsWe tested cerebrospinal fluid (CSF) using a stepwise meningitis diagnostic algorithm including BioFire ME. We determined the diagnostic performance of BioFire ME for cryptococcal meningitis, using cryptococcal antigen (CrAg) and CSF culture as reference standards, and assessed other central nervous system (CNS) pathogens identified by the panel. ResultsWe evaluated 328 adult and 42 pediatric CSF specimens using BioFire ME. Of the adult CSF samples tested, 258 were obtained at baseline, and 70 were obtained from repeat lumbar punctures in cryptococcal meningitis. For Cryptococcus, sensitivity was 82%, specificity was 98%, PPV was 98%, and NPV was 79% in baseline specimens using CSF CrAg as the reference standard. Among follow-up specimens, a negative BioFire ME for Cryptococcus predicted CSF culture sterility with 84% NPV. Overall sensitivity was decreased at low fungal burdens: 29% for 0–99 Cryptococcus CFU/mL compared to 94% for ≥100 CFU/mL in baseline specimens. Other pathogens detected included E. Coli, H. influenzae, S. pneumoniae, CMV, enterovirus, HSV, HHV-6, and VZV. Two specimens tested positive for S. pneumoniae and one for Cryptococcus in the pediatric population. ConclusionsMultiplex PCR is a promising rapid diagnostic test for meningitis in adults and children in resource-limited settings. Cryptococcus at low fungal burdens in CSF may be missed by BioFire ME.

Longitudinal Changes in Epigenetic Age Acceleration in Aviremic Human Immunodeficiency Virus-Infected Recipients of Long-term Antiretroviral Treatment.

Human immunodeficiency virus (HIV) infection induces epigenetic age acceleration (EAA), but it remains unclear whether epigenetic aging continues to accelerate during successful antiretroviral therapy (ART) and prolonged virological suppression. We longitudinally analyzed 63 long-term aviremic HIV-infected adults. Using blood DNA methylation patterns, we calculated EAA measures based on 3 epigenetic clocks (Horvath's clock, PhenoAge, and GrimAge). We recorded the emergence of serious AIDS-related and non-AIDS-related events throughout the study to assess its association with EAA. All participants were on stable ART and were virologically suppressed. After 4 years of follow-up, PhenoAge-EAA and GrimAge-EAA showed no differences, whereas Horvath-EAA slightly decreased (median difference, -0.53 years; P = .015). Longitudinal changes in EAA measures were independent of changes in CD4 cell counts, the ART regimen, or other HIV-related factors. Nineteen percent of participants experienced a serious clinical event during the study. Horvath-EAA was significantly higher at baseline in participants with clinical events (P = .027). After adjusting for confounders, we found a trend toward an association of higher levels of all EAA measures at baseline with serious clinical events. Epigenetic aging did not accelerate in long-term aviremic HIV-infected adults after 4 years of successful ART. EAA measures deserve further study as potential tools for predicting clinical events.

Association between handgrip strength and bone mass parameters in HIV-infected children and adolescents. A cross-sectional study.

Low bone mineral content (BMC) and bone mineral density (BMD) have been identified in human immunodeficiency virus (HIV)-infected children and adolescents. The direct adverse effects of HIV infection and combined antiretroviral therapy (ART) negatively contribute to bone metabolism. A direct relationship between muscle strength levels and BMD in HIV-infected adults and older adults has been described. However, it is unknown whether handgrip strength (HGS) is associated with bone mass in pediatric populations diagnosed with HIV. To ascertain whether HGS levels are associated with BMC and BMD in HIV-infected children and adolescents. Cross-sectional study conducted in Florianãpolis, Brazil, in 2016. The subjects were 65 children and adolescents (8-15 years) diagnosed with vertically-transmitted HIV. Subtotal and lumbar-spine BMC and BMD were obtained via dual-emission X-ray absorptiometry (DXA). HGS was measured using manual dynamometers. The covariates of sex, ART, CD4+ T lymphocytes and viral load were obtained through questionnaires and medical records. Sexual maturation was self-reported and physical activity was measured using accelerometers. Simple and multiple linear regression were used, with P < 0.05. HGS was directly associated with subtotal BMD (β = 0.002; R² = 0.670; P < 0.001), subtotal BMC (β = 0.090; R² = 0.734; P = 0.005) and lumbar-spine BMC (β = 1.004; R² = 0.656; P = 0.010) in the adjusted analyses. However, no significant association was found between HGS and lumbar-spine BMD (β = 0.001; R² = 0.464; P = 0.299). HGS was directly associated with BMD and BMC in HIV-infected children and adolescents.