HIV-infected Participants Research Articles

Iron status, anemia, and birth outcomes among pregnant women in urban Bloemfontein, South Africa: the NuEMI study

BackgroundDespite routine iron supplementation for pregnant women in South Africa, anaemia and iron deficiency (ID) in pregnancy remain a public health concern.ObjectiveTo determine the associations between iron status and birth outcomes of pregnant women attending antenatal clinic at a regional hospital in Bloemfontein.MethodsIn this cross-sectional study of 427 pregnant women, blood was taken to analyze biomarkers of anaemia (haemoglobin), iron status (ferritin and soluble transferrin receptor) and inflammation (C-reactive protein and α-1-acid glycoprotein). A questionnaire was used to collect information about birth outcomes (birth weight and gestational age at birth), HIV exposure, sociodemographics, iron supplement intake, and maternal dietary iron intake using a validated quantified food frequency questionnaire.ResultsThe median (Q1, Q3) weeks of gestation of participants was 32 (26, 36) at enrolment. Anaemia, iron deficiency (ID), ID anaemia (IDA) and ID erythropoiesis (IDE) were present in 42%, 31%, 19% and 9.8% of participants, respectively. Median (Q1, Q3) dietary and supplemental iron intake during pregnancy was 16.8 (12.7, 20.5) mg/d and 65 (65, 65) mg/d, respectively. The median (max-min) total iron intake (diet and supplements) was 81 (8.8-101.8) mg/d, with 88% of participants having a daily intake above the tolerable upper intake level of 45 mg/d. No significant associations of anaemia and iron status with low birth weight and prematurity were observed. However, infants born to participants in the third hemoglobin (Hb) quartile (Hb > 11.3–12.2 g/dL) had a shorter gestation by 1 week than those in the fourth Hb quartile (Hb > 12.2 g/dL) (p = 0.009). Compared to pregnant women without HIV, women with HIV had increased odds of being anaemic (OR:2.14, 95%CI: 1.41, 3.247), having ID (OR:2.19, 95%CI: 1.42, 3.37), IDA (OR:2.23, 95%CI: 1.36, 3.67), IDE (OR:2.22, 95%CI: 1.16, 4.22) and delivering prematurely (OR:2.39, 95%CI: 1.01, 5.64).ConclusionIn conclusion, anaemia, ID, and IDA were prevalent in this sample of pregnant women, despite the reported intake of prescribed iron supplements, with HIV-infected participants more likely to be iron deficient and anaemic. Research focusing on the best formulation and dosage of iron supplementation to enhance iron absorption and status, and compliance to supplementation is recommended, especially for those living with HIV infection.Graphical

A Randomized, Double-Blind, Placebo-Controlled, Short-Term Monotherapy Study of MK-6186, an HIV-1 Non-Nucleoside Reverse Transcriptase Inhibitor, in Treatment-Naïve HIV-Infected Participants.

Objective: To assess the antiviral activity, pharmacokinetics, and safety of MK-6186 in HIV-1 non-nucleoside reverse transcriptase inhibitor (NNRTI)-naïve, HIV-1-infected male participants. Design: Double-blind, randomized, two-panel study. Methods: In 2 sequential panels, 18 participants received MK-6186 (40 mg [Panel A] or 150 mg [Panel B]) or matching placebo once daily for 7 days. Plasma samples were collected for measurement of HIV-1 RNA levels and MK-6186 pharmacokinetics. Results: For the mean change from baseline in HIV-1 RNA (log10 copies/mL) at 24 h post Day 7 dose, the mean difference (90% confidence interval) between MK-6186 and placebo was -1.54 (-1.73, -1.34) in the 40-mg group and -1.28 (-1.81, -0.75) in the 150-mg group. One participant in the 150-mg group had viral rebound at 24 h after Day 6 dosing (Day 7 predose) associated with outgrowth of the V106A minority variant. Ultra-deep sequencing confirmed expansion of this predose minority variant from 0.26% to 63.67%. No outgrowth or rebound was seen in another participant in whom a V106A minority variant was also detected. MK-6186 was generally well tolerated. MK-6186 was rapidly absorbed with peak concentrations at 2 h followed by a biphasic decline. The effective t½ of MK-6186 was 43.9 to 48.7 h. Steady state was not achieved. Conclusions: Daily monotherapy with MK-6186 demonstrated robust antiviral activity with maximal antiviral activity at a dose of 40 mg. One participant in the 150-mg group exhibited viral rebound with outgrowth of the resistant V106A minority variant, demonstrating a risk of resistance development typical of NNRTIs. The reason for this outgrowth remains unclear as no outgrowth occurred in a participant in the 40-mg group in whom the V106A minority variant was also detected. MK-6186 may be an alternative next-generation NNRTI in combination therapy, in that combination antiretroviral therapy could prevent outgrowth of resistant minority variants.

Association of first-line combination antiretroviral therapy with malaria among adult HIV-infected persons in Jos, Nigeria: a pilot cross sectional study

BackgroundMalaria and human immunodeficiency virus (HIV) infection coexist in significant numbers in some geographic areas including sub-Sahara Africa (SSA). HIV-infected patients are a World Health Organization (WHO) recognized high risk group for increased malaria morbidity. Majority of HIV-infected patients undertaking treatment in SSA are on WHO recognized first-line combination antiretroviral therapy (cART). Considering the immunity-enhancing capacity of antiretroviral therapies on people living with HIV, this study aimed to explore the association between first-line combination antiretroviral therapy (cART) with malaria parasitaemia and antigenaemia in adult HIV-infected persons and to determine the predictors of malaria antigenaemia in adult persons living with HIV.MethodsThe study was conducted at the AIDS Prevention Initiative in Nigeria (APIN) Centre, Jos University Teaching Hospital, Jos, Plateau State, from August 2018 to February 2019. Epi Info statistical tool was used to determine the sample size and power of the study. The study population consisted of three groups. The first group comprised first-line cART-experienced adult HIV-seropositive subjects, the second group comprised ARV-naïve HIV-seropositive adults and the third group comprised HIV-seronegative adults. For this pilot study, 60 persons were recruited into each group via convenience sampling. Malaria rapid diagnostic test (RDT) was performed according to manufacturer’s instruction for all the study participants using SD Bioline Malaria Ag P.f (HRP2/pLDH) (Standard Diagnostics, Hagal-Dong, Korea). All the study participants also had thick and thin blood film malaria microscopy. Data collected was processed and analyzed using the Stata statistical software version 15 (StataCorp, College Station, Texas). Chi square was used to test the association between malaria and first-line cART exposure. Univariate and multivariate analysis were also done to identify factors that were independently associated with malaria antigenaemia.ResultsA total of 180 persons participated in the study and involved 60 participants recruited in each of the three study groups. Overall, the predominant study participants were females (56.67%), traders (27.78%), secondary school leavers (43.33%) and urban dwellers (88.89%). Their mean age and standard deviation was 37.07 ± 11.53 years. Using malaria microscopy, the prevalence of malaria parasitaemia in ARV-naïve HIV-infected persons was 5% and 0% in the first-line cART-experienced HIV-infected persons as well as the HIV-negative persons. Malaria RDT result was positive in 7/60 (11.67%) of the first-line cART experienced HIV-infected participants, 6/60 (10%) of the ARV-naïve HIV-infected group and 1/60 (1.67%) of the HIV-negative group. Of the seven positive malaria RDT results in those on first-line cART, five persons were receiving zidovudine/lamivudine/nevirapine (AZT/3TC/NVP) while the remaining two were receiving tenofovir disoproxil fumarate/lamivudine/efavirenz (TDF/3TC/EFV), thus making an antigenaemia proportion of 16.67% and 6.67% respectively. Being an HIV-infected person on first-line cART (OR = 16.20, p = 0.04), having a headache (OR = 6.21, p = 0.03) and non-usage of window nets (OR = 3.74, p = 0.05) were found to be predictors of malaria antigenaemia.ConclusionMalaria parasite burden in HIV-infected persons on first-line cART is lower than that observed in ARV-naïve HIV-infected persons. Our study suggests that TDF/3TC/EFV may be associated with lower malaria antigenaemia when compared with AZT/3TC/NVP and can be considered an alternative first-line antiretroviral regimen in malaria-endemic regions.

Possible alteration in serum ferritin level in malaria infected HIV seropositive individuals in Nauth, Nnewi, Nigeria

The role of Ferritin in monitoring disease progression in immune compromised HIV individuals with an underlying active infection like malaria is a subject of growing research. Ferritin being an acute phase protein, plays important role in assessing the range of damage due to inflammation in immunosuppressed patients leaving in highly endemic malaria regions. The levels of serum ferritin in malaria infected HIV positive individuals in Nnamdi Azikiwe University teaching hospital (NAUTH), Nnewi, Anambra State, Nigeria, was assessed. Questionnaire was used to obtain the demographic details of the participants, and to rule out other inflammatory infections. 88 participants of the age group 18 - 65 years, comprising 24 with HIV infection, 22 with HIV and Malaria co-infection, 22 with Malaria infection, and a control group of 22 individuals with neither HIV nor malaria infection were randomly recruited. Ferritin level was determined using enzyme linked immunosorbent assay technique and a cross sectional prospective study design was used. A significantly high mean serum ferritin level was observed in HIV infected individuals with and/ or without malaria co-infection than in malaria positive and control group (p<0.05 respectively). Serum ferritin level was significantly higher in female participants than in male counterparts (p < 0.05). Serum ferritin level was significantly higher in individuals with CD4 count >500 than in CD4 count ≤ 500 (p < 0.05). Blood pressure was significantly higher in HIV infected and malaria positive individuals when compared with controls. The increased serum ferritin level and higher blood pressure in HIV infected participants suggests active inflammatory process, reduced immunity and hypertension which may have worsened by malaria co-infection. This may subsequently lead to vascular and endothelia damage causing disease severity.

Neurocognitive Impairment among HIV-Infected Participants on Methadone for IV-Heroin use in Yunnan, China Relates to AIDS Status and Depression Severity, not Patterns of Substance use

We used a comprehensive and culturally normed battery of Neurocognitive (NC) tests to evaluate NC impairment (NCI) in 406 adults with prior IV heroin use who were in a government-supervised methadone maintenance program in Yunnan province, China. Participants included 202 without HIV infection, 57 with AIDS, and 147 HIV+ without AIDS (“nonAIDS group”). The AIDS group had higher proportions of individuals with global NCI (38.6%) relative to nonAIDS (15.7%) and HIV- participants (17.3%; ps < 0.01). The AIDS group performed worse than the non AIDS group globally (< 0.001), and in the domains of executive functioning (ps = 0.001), learning (ps = 0.035), and speeded information processing (ps = 0.0002). Despite the lack of difference in prevalence of NCI between non AIDS and HIV- groups, the non AIDS group showed impairment in memory and complex motor domains relative to the HIV- group (p = 0.03). In People With HIV (PWH), NCI was associated with more severe depression symptoms and HIV disease characteristics (duration of illness, CD4 nadir, AIDS status). Nearly all participants were HCV infected. Alcohol use disorder diagnoses, non-invasive indications of liver fibrosis, and characteristics of prior heroin use were not associated with NCI. PWH with NCI had worse daily functioning, as indexed by unemployment (ps = 0.016) and reported increased cognitive difficulties in daily life (ps = 0.016). These results highlight the importance of early HIV diagnosis and treatment to avoid HIV disease progression, particularly among IV drug users, with the goal of protecting NC abilities, everyday functioning, and life quality in infected individuals.

Limited HIV-associated neuropathologies and lack of immune activation in sub-saharan African individuals with late-stage subtype C HIV-1 infection.

Although previous studies have suggested that subtype B HIV-1 proviruses in the brain are associated with physiological changes and immune activation accompanied with microgliosis and astrogliosis, and indicated that both HIV-1 subtype variation and geographical location might influence the neuropathogenicity of HIV-1 in the brain. The natural course of neuropathogenesis of the most widespread subtype C HIV-1 has not been adequately investigated, especially for people living with HIV (PLWH) in sub-Saharan Africa. To characterize the natural neuropathology of subtype C HIV-1, postmortem frontal lobe and basal ganglia tissues were collected from nine ART-naïve individuals who died of late-stage AIDS with subtype C HIV-1 infection, and eight uninfected deceased individuals as controls. Histological staining was performed on all brain tissues to assess brain pathologies. Immunohistochemistry (IHC) against CD4, p24, Iba-1, GFAP, and CD8 in all brain tissues was conducted to evaluate potential viral production and immune activation. Histological results showed mild perivascular cuffs of lymphocytes only in a minority of the infected individuals. Viral capsid p24 protein was only detected in circulating immune cells of one infected individual, suggesting a lack of productive HIV-1 infection of the brain even at the late-stage of AIDS. Notably, similar levels of Iba-1 or GFAP between HIV + and HIV- brain tissues indicated a lack of microgliosis and astrogliosis, respectively. Similar levels of CD8 + cytotoxic T lymphocyte (CTL) infiltration between HIV + and HIV- brain tissues indicated CTL were not likely to be involved within subtype C HIV-1 infected participants of this cohort. Results from this subtype C HIV-1 study suggest that there is a lack of productive infection and limited neuropathogenesis by subtype C HIV-1 even at late-stage disease, which is in contrast to what was reported for subtype B HIV-1 by other investigators.

Rapid decrease in IL-1Ra and IP-10 plasma levels following tuberculosis treatment initiation

ObjectivesMonitoring tools that could provide quick predictions of tuberculosis (TB) treatment outcomes are urgently needed. Here, we assessed whether the evolution of selected biomarkers of innate immunity may help monitoring TB treatment response within 2 weeks of treatment initiation. MethodsANRS12394-LILAC-TB was a proof-of-concept prospective study: adults with a rifampicin-susceptible TB who are HIV-negative and HIV-infected documented by a positive Xpert MTB/RIF test were enrolled in Cambodia and Côte d'Ivoire. Plasma concentrations of interleukin-1 receptor antagonist (IL-1Ra), interferon-γ–induced protein-10 and clusters of differentiation (CD) (scavenging CD163) were measured by commercial enzyme-linked immunosorbent assay kits. A Wilcoxon test for paired data was used for longitudinal comparisons. ResultsA total of 55 patients were enrolled (women: 31%, median age: 37 years; median CD4 count in the 10 of 13 participants with HIV: 53 cells/mm3). Overall, 83% were considered in TB treatment success. Compared with baseline, the IL-1Ra plasma levels significantly decreased as soon as week (W) 1, independent of HIV status (−71% in HIV-positive vs −33% in HIV-negative; P <0.001). The IP-10 plasma levels significantly decreased at W1 and W2 compared with baseline (P <0.0001); however, that decrease was less marked in participants with HIV. ConclusionsOur findings suggest that measuring IL-1Ra plasma levels with a standard enzyme-linked immunosorbent assay technique at baseline and then 1 week after TB treatment onset could help clinicians to quickly assess TB treatment response.

Effects of SNPs on TNF-α and IL-10 cytokine expression in TB and HIV patients in the Capricorn district, Limpopo Province, South Africa.

The impact of Tuberculosis (TB) places an immense burden on the health care system. Infection with Human Immunodeficiency Virus (HIV) is a significant risk factor in the development and progression of TB disease. Single Nucleotide Polymorphisms (SNPs) in the promoter region of Interleukin-10 (IL-10) and Tumour Necrotic Factor-Alpha (TNF-α) may play a major role in the disease mechanism and understanding these mechanisms might prove to be a useful diagnostic tool in evaluating the immune regulation and progression of the disease. This study aimed to determine the relationship between cytokine levels and gene variants of Interleukin-10 and Tumour Necrotic Factor Alpha in TB and HIV-infected participants. Cytokine levels were determined by ELISA, and SNPs were determined by MassArray®. The levels of TNF-α were higher in the TB group than the HIV (p < 0.001) and TB-HIV (p = 0.011) groups, but similar to the TNF-α levels in the control group. In the HIV group, IL-10 levels were higher than those of the TB (p < 0.001) and control groups (p = 0.039), whereas there was no difference between the IL-10 levels in the HIV and the TB-HIV infection groups. The ratio was determined and there were no differences between the four infection groups. In this study, no associations were detected between the circulating plasma levels of TNF-α and IL-10 and their genotypes. Our data showed that the gene variants were not associated with circulating plasma levels of TNF-α and IL-10 in our study population. A pro-inflammatory environment was found in the TB and TB-HIV groups, which is suggesting of bacterial clearance, while an anti-inflammatory environment was found in the HIV group, which suggests the suppression of viral replication.

Prevalence of syphilis and associated risk factors among human immunodeficiency virus-infected patients at the Lagos University Teaching Hospital Nigeria: A cross-sectional study

Background: Worldwide, there was an estimated 7.1 million new cases of syphilis in 2020, and most of the infections were found in developing countries like Nigeria. The objective of the study was to determine the prevalence and risk factors for syphilis among human immunodeficiency virus (HIV)-infected patients in Lagos. Methods: A cross-sectional study was conducted in an HIV Clinic in Lagos, Nigeria, from April to June 2017 and 385 HIV-infected adult participants 18 years and above were recruited into the study. Structured questionnaires were used to collect data on sociodemographic and risk factors for syphilis. Blood samples were collected from all participants and tested for syphilis using rapid plasma reagin and Treponema pallidum hemagglutination assay test kits. Data were analyzed using SPSS (IBM) V. 20. Bivariate analysis was carried out using Chi-square, Fisher’s exact test, and Student’s t-test on sociodemographic and risk behavioral factors. Multivariable logistic regression analysis was performed with variables that were significantly associated with syphilis in bivariate analysis. A P &lt; 0.05 was considered to be statistically significant. Results: Out of 388 HIV-infected patients recruited into the study, 262 (67.5%) were female. The mean age was 43.6 ± 10.1 years, and 137 (35.3%) of them were in the age group of 41–50 years. The prevalence of syphilis in HIV-infected patients was 1.8%. The prevalence of syphilis was significantly higher in males (4.8%) than females (0.4%). The prevalence of syphilis was higher in those with no education or primary school education, and multiple sexual partners were statistically significant in the bivariate analysis but not in the multivariate analysis. Male gender was the only independent risk factor for syphilis, with an odds ratio of 11.79 (95% confidence interval [1.26–106.5], P = 0.03) in multivariate analysis. Conclusion: The prevalence of syphilis in this study was lower than previous work done in other HIV-positive cohorts in Nigeria. Males were more affected significantly in this study. Routine screening and testing for syphilis should be integrated into HIV care, especially in males.

Carbapenem Resistance among HIV-Infected Patients: A Scoping Review

Background: Antibiotic resistance is an escalating global health concern, with carbapenems, potent last-line antibiotics, facing increasing resistance and potentially dire consequences. This scoping review sought to consolidate data on carbapenem resistance in human immunodeficiency virus (HIV)-infected patient cohorts as the intricate relationship between HIV and antibiotic resistance remains inadequately understood. Methods: We employed a scoping review methodology and conducted a comprehensive search across Google Scholar, Scopus, Cochrane, and PubMed, utilizing specific search terms related to carbapenem resistance and HIV. We extracted and analyzed data, encompassing study design, geographic location, number of HIV-infected participants, CD4 cell counts, specimen types, cultured organisms, carbapenem susceptibility, and comparisons between HIV-infected and uninfected cohorts. Results: This review encompassed 15 studies, involving 2365 HIV-infected participants, primarily employing cross-sectional designs, with nine studies conducted in African countries. The most frequently analyzed specimens included urine, stool, and sputum, with Escherichia coli emerging as the most frequently cultured organism. Commonly used carbapenem drugs included imipenem, meropenem, and ertapenem, with varying susceptibility patterns. Imipenem and meropenem exhibited sensitivities exceeding 80%, except for one study with Pseudomonas aeruginosa, which demonstrated 73% sensitivity. Ertapenem displayed fluctuating sensitivities ranging from 58% to 100% for different bacterial organisms. Only one study reported the colonization of carbapenem-resistant Enterobacterales (CRE) in HIV-infected patients, with HIV status not significantly influencing CRE carriage. When comparing HIV-infected and uninfected cohorts, four studies found no substantial impact of HIV status on carbapenem resistance. Conclusion: In the context of the HIV burden and opportunistic infections, carbapenem resistance demonstrated relatively consistent patterns across most studies comparing HIV-infected and uninfected cohorts. However, the presence of CRE among HIV-infected individuals raises concerns regarding nosocomial infections. The limited reporting of CD4 counts in the included studies necessitates further exploration of potential associations with immune status. E. coli, frequently cultured in these studies, exhibited varying resistance patterns, and the impact of HIV on these patterns remains uncertain. Carbapenem susceptibility displayed variability among different organisms, underscoring the nuanced nature of resistance. As such, this scoping review serves as a foundation for comprehending carbapenem resistance in HIV-infected populations but underscores the necessity for more comprehensive research in this field.

Immunogenicity and safety of inactivated SARS-CoV-2 vaccines in people living with HIV: A longitudinal cohort study.

To clarify the characteristics in immunogenicity and safety of inactivated SARS-Cov-2 vaccines among HIV-infected individuals, a longitudinal cohort study was performed on HIV-infected and HIV-uninfected participants with no history of COVID-19 infection and COVID-19 vaccine inoculation. Participants information and adverse events were collected. Blood samples were collected on the same day before vaccination, 21 days after the first shot, 28 days after the second shot, 6 months after the second vaccination and 14 days after the third dose to test anti-receptor-binding domainIgG antibody, viral load, CD4+, CD8+ T cell count. Our result showed that although HIV-infected adults with low nadir CD4+ T cell count ≤ 350 cells/mm3 generate significantly lower immune response after three shots of vaccine compared with HIV-negative controls, 100% of all the HIV-infected and healthy controls were seroconverted after the third shot. Seroconversion ratio and antibody level of 190 days after two shots of vaccination for HIV-infected with nadir CD4+ T cell count ≤ 350 were significantly lower than that of healthy controls. No significant difference was found in viral load among blood samples collected at each time points. CD4 and CD4/CD8 ratio value were found increased greatly after each shot of inoculation in HIV-infected individuals with nadir CD4+ T cell count ≤ 350. Multiple logistic regression analysis showed that among HIV-infected individuals, PLWH with CD4+ T cell count ≤ 350 were less likely experience seroconversion 21 days after the first shot, and less likely maintained antibody immunity 6 months post 2nd dose. Adverse events after each inoculation were not serious and recovered within 1 week. In conclusion, inactivated COVID-19 vaccine was safe and effective in people living with HIV after three shots of vaccination. HIV-infected individuals with low nadir CD4+ T cell count ≤ 350 was associated with a nonoptimal antibody response. Further vaccination strategies could be developed for those with low CD4+ T cell counts.

Correlational studies on clinical and laboratory diagnoses of Trichomonas vaginalis coinfection with HIV candidiasis and syphilis among women of reproductive age in Jalingo North-central Nigeria

Background &amp; objective: The high prevalence of Trichomonas vaginalis infection globally and the frequency of co-infection with other STIs make Trichomoniasis a compelling public health concern. Research has shown that T. vaginalis infection is associated with high risk of several sexually transmitted infections. This study was to provide information on the coinfection rate with some STDs and the correlation between clinical diagnoses and confirmatory laboratory diagnosis among women of reproductive age in Jalingo. Methods: A prospective, cross-sectional and laboratory- based research was carried out on the Correlational studies on clinical and laboratory diagnoses of T. vaginalis and it co-infection with HIV Candidiasis and Syphilis among women of reproductive age in Jalingo North-Central Nigeria, between November 2022 to March 2023. A health facility (Mimllins Laboratories Limited) was selected from Jalingo local government area. One hundred (100) Women within the reproductive age group of 15 to 50 years, seeking health care in the selected facility that fulfilled the inclusion criteria and grant consent were enrolled. A pretested structured interviewer’s questionnaire was used to collect data on clinical presentation. Results: A total of 100 eligible women between the ages of 15 to 50 years’ resident in Jalingo, Taraba State and attends to at the selected facility were examined. The overall prevalence of Trichomoniasis among the general population was 13%. For co-infection rates with HIV, syphilis, and Candidiasis, all the HIV-infected participants (4) had T. vaginalis infection while 70% (7/10) of the population that had syphilis had T. vaginalis infection. Both diseases (HIV and Syphilis) had a very strong association with T. vaginalis infection among the population (both p-values= 0.000). Candidiasis on the other hand had no significant association with T. vaginalis infection (p=1.000). Based on the clinical diagnosis, abdominal pain and burning sensation gave strong associations with T. vaginalis infection (p values were 0.001 and 0.005 respectively). However, the reverse was the case for vaginal itching and discharge (both p-values were 1.000). Conclusion: A greater percentage of T. vaginalis positive women came to the laboratory because they had related uncomfortable symptoms. This is problematic since some women in this area are unaware of the importance of having regular gynecological examinations unless symptoms appear. Hence, general surveillance for sexually transmitted diseases, an effective way to prevent T. vaginalis infection, is needed.

Efficacy of Lactococcus lactis strain Plasma on clearance of anal HPV infection in men who have sex with men: A single-center, double-blinded, randomized placebo-controlled trial (CLEAR HPV study)

Background: Anal cancer is a human papillomavirus-related cancer; specifically, it is preceded by high-grade squamous intraepithelial lesions, which are less likely to regress spontaneously than low-grade intraepithelial lesions. Although most human papillomavirus (HPV) infections are thought to clear spontaneously, anal HPV infection persists, especially in people living with HIV. Preliminary results from a recent small randomized placebo-controlled trial of oral bacteriotherapy using a high dose of probiotics demonstrated clearance of anal high-risk HPV (hr-HPV) infection and lower onset of new high-grade squamous intraepithelial lesions among people living with HIV. Lactococcus lactis strain Plasma is a lactic acid bacterium directly activating plasmacytoid dendritic cells and inducing release of type I and III interferons via Toll-like receptor 9 stimulation. Based on these findings, oral bacteriotherapy with LC-plasma may contribute to clearing anal hr-HPV infection and reducing anal precancerous lesions by activating innate and acquired immune responses. This randomized placebo-controlled trial aims to investigate the efficacy and safety of LC-plasma therapy in clearing anal hr-HPV infection and reducing anal precancerous lesions among men who have sex with men with or without HIV infection. Methods: Participants with anal hr-HPV infection will be included and receive test capsules. A total of 150 patients will be included in the intervention group with follow-up, which will consist of HPV genotype test, cytology by anal pap smear, and biopsy with high-resolution anoscopy. The primary endpoint will be the clearance rate of the hr-HPV genotype infection at the anal site at 180 days. The secondary endpoints will be changes in anal epithelial neoplasia detected using high-resolution anoscopy at 180 days; change in abnormal cytology by anal pap smear at 180 days; change in hr-HPV genotype at the anal site at 180 days; change or percentage change in peripheral blood CD4 positive T-lymphocyte numbers in HIV-infected participants at 180 days; changes in quantitative hepatitis B surface antigen levels at 180 days in the HBV-infected participants; and adherence to the study drugs. Conclusion: This randomized controlled study will provide data on the efficacy and safety of LC-plasma as a treatment for anal HPV infection and grade 2 or 3 anal intraepithelial neoplasia.

Human papillomavirus positivity and cervical lesions in relation to HIV infection: a comparative assessment in the Cameroonian female population.

Cervical lesions, induced by high-risk oncogenic human papillomavirus (HR-HPV), in the context of HIV remains a global health challenge. We determined the effect of HR-HPV on the development of cervical lesions in women with and without HIV infection. A cross-sectional analytical study was conducted among 257 women living in Cameroon. HIV serology, HR-HPV genotyping and cervico-vaginal smear (CVS) were performed for all participants; among those declared HIV positive, plasma HIV viral load and CD4 count were measured. Statistical analyses were performed using Graph Pad version 6.0; P#x003C;0.05 was considered statistically significant. The mean age of the participants in our study was 37±6.5 years. According to HIV serology, 184 (71.59%) were HIV-positive vs. 73 (28.40%) HIV-negative. Among the HIV-positive women, the median CD4 count was 438 [IQR: 317-597] cells/mm3 and the median viremia was #x003C;40 [IQR: #x003C;40-2318] copies/ml. After successful genotyping, the prevalence of HR-HPV was 36.32% (73/201), with a significantly higher proportion in HIV-infected individuals (41.98% (55/131) vs. 25.71% (18/70); P=0.02; OR=2.1). The overall rate of cervical lesions was 23.34% (60/257), with a non-significantly higher proportion in HIV-infected participants (25.00% (46/184) vs. 19.17% (14/73); P=0.31). Relevantly, the presence of HR-HPV was significantly associated with cervical lesions (P#x003C;0.0001; OR=5.07), with a higher odds of cervical lesion in HIV-positive individuals (P#x003C;0.0001 and OR=5.67) compared to HIV-negative individuals (P=0.03 and OR=3.83). Although oncogenic HPV appears to be an independent factor in the development of cervical lesions, this study reveals higher odds of cervical lesions among HIV/HPV co-infection than in HPV infection alone.

Seroprevalence of syphilis among human immunodeficiency virus seropositive clients in Ndagiri, Gwagwalada Abuja Nigeria

Syphilis facilitates both HIV transmission and acquisition, reflecting the complex interplay between the two infections. Scarce information exists regarding syphilis epidemiology in Nigeria. Thus, this study determined the sero-prevalence of syphilis among people attending ART Clinic Ndagiri primary health care centre Gwagwalada area of Federal Capital Territory Abuja Nigeria. A cross-sectional study was conducted from July to September, 2019. 290 HIV–infected participants were studied; but individuals under 20 years of age and above 60 years were excluded. Structured questionnaires were used to collect data on socio-demography. Moreover, blood samples were collected from all participants and screened for syphilis using rapid test kit, and those found sero-positive were confirmed using Polymerase Chain Reaction assay (PCR).Out of 290 samples collected and analyzed, result shows the general prevalence of 0.35% among ART patients in UATH. In regards to sex, 0.52% prevalence was recorded with a significant P-value of 0.04. 0.65% prevalence was however recorded among age group 31-40 with an insignificant P-value 0.09. A higher prevalence was found among singles with 1.24% which was still insignificant with a P-value of 0.095. Conclusively, despite this low prevalence recorded, awareness campaigns, Syphilis screening and testing service with HIV/AIDS care is critically needed which could limit the clinical consequences of untreated Syphilis as well as its adverse impact on HIV transmission.

Prevalence and antifungal susceptibility pattern of oral candidiasis among HIV-infected patients in a Mission Hospital, southeast Nigeria

Background: Oral candidiasis is an infection that follows colonization of oral cavity by Candida species mostly Candida albicans. About 90% of HIV-infected persons develop this disease during the course of HIV infection and could serve as early sign of HIV-related immunodeficiency. Treatment involves the use of antifungal drugs. The objectives of this study are to determine the prevalence of oral candidiasis and the susceptibility of isolated Candida species to available antifungal agents among selected HIV-infected patients in a mission hospital, southeast Nigeria.&#x0D; Methodology: This was a descriptive cross-sectional study of 150 consecutively selected HIV-infected patients attending the Heart-to-Heart clinic of Iyi-Enu mission hospital Ogidi, Anambra State, Nigeria, between December 2022 and February 2023. Demographic information of each participant was obtained using structured questionnaire. Five milliliters of whole blood were drawn from the antecubital vein of each participant for CD4+ estimation. Mouth specimens were collected using two sterile cotton swabs for microscopy and culture on Sabouraud Dextrose Agar, and Candida species were identified after subculture on CHROMAgar. Antifungal susceptibility testing was performed by Kirby-Bauer disk diffusion method using fluconazole, clotrimazole, ketoconazole, and nystatin disks, and results interpreted according to the guidelines of the Clinical and Laboratory Standards Institute.&#x0D; Results: A total of 98 (65.3%) HIV-infected participants were positive for oral candidiasis, with 4 species of Candida isolated; Candida albicans (62.2%), Candida glabrata (18.4%), Candida tropicalis (12.2%) and Candida krusei (7.1%). Fifty-nine (60.2%) of the 98 participants had CD4+ cell count ˂ 200, 33 (33.7%) had counts in the range of 200-399, and 6 (6.1%) had counts in the range of 400-499 cells/μL (p=0.001). The prevalence of candi- diasis was not significantly different between the female (67.0%, 65/97) and male (62.3%, 33/53) participants (p=0.6598), but the prevalence was significantly higher (p&lt;0.05) in participants age group 21-30 years (80.7%, 42/52), divorced (100%, 1/1) and married (75%, 45/60), those with primary school level education (73.7%, 42/57), civil servants (85.7%, 18/21), and those who performed mouth hygiene once daily (71.9%, 69/96). Nystatin (77.6%, 76/98) showed the highest while fluconazole and ketoconazole (68.4%, 62/98) showed the lowest in vitro antifungal activity&#x0D; Conclusion: Oral candidiasis is prevalent among HIV-infected patients in the study population, with evidence of in vitro resistance of the Candida isolates to available antifungal drugs. Proper diagnosis, susceptibility testing and treatment of infection will be helpful in managing oral candidiasis infection among HIV infected patients.

Prevalence and risk factors for hepatitis C virus infection among HIV positive patients at the Lagos University Teaching Hospital, Nigeria

Background: Worldwide, an estimated 58 million people have chronic hepatitis C virus (HCV) infection, with about 1.5 million new infections occurring per year. About 2.3 million people living with HIV globally have serological evidence of past or present HCV infection. The aim of this study was to determine the prevalence of active HCV infection and associated risk factors among HIV positive patients attending the HIV clinic, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria.&#x0D; Methodology: A cross sectional study was conducted to determine the prevalence of and risk factors for HCV infection among randomly selected HIV positive patients at the LUTH HIV clinic. Socio-demographic, clinical and laboratory data were collected from the participants using a structured questionnaire. Blood samples were collected and tested for HCV antibodies with an enzyme linked immunosorbent assay (CTK Biotech USA) and HCV RNA was detected using reverse transcriptase polymerase chain reaction assay.&#x0D; Results: One hundred and ninety-five HIV infected participants were recruited into the study of which 134 (68.7%) were females and 61 (31.3%) were males. The mean age of participants was 40.1±7.8 years. Of the 195 participants, 5 tested positive for antibody to HCV, giving a seroprevalence rate of 2.6% (95% CI = 0.8-5.9%). Of the 5 seropositive participants, HCV RNA was detected in 1 (20.0%), giving a prevalence of 0.5% (1/195) for active HCV infection. The seroprevalence of HCV in males of 4.9% (3/61) and females of 1.5% (2/134) was not significantly different (OR=3.41, 95% CI=0.56-20.98%, p=0.18). The mean log10 HIV viral load was significantly higher among participants seropositive for HCV (5.1±0.9 log copies/ml) than those seronegative (2.7±1.2 log copies/ml) (p &lt; 0.001). The mean duration of antiretroviral therapy was significantly lower among participants seropositive for HCV (2.6±1.3 years) than those seronegative (5.6±3.1 years) (p=0.004). The seroprevalence of HCV was significantly higher in those with CD4 count &lt;350 cells/mm3 (8.5%) than those with CD4 count &gt;350cells/mm3 (p=0.02). The seroprevalence of HCV in the HIV-positive participants was significantly associated with sexual partners (p=0.0473), with highest seroprevalence in those with ≥ 3 sexual partners (OR=11.625, 95% CI=1.049-128.83). Other risk factors were not significantly associated with seroprevalence of HCV (p&gt;0.05), while risk factors associated with active HCV infection could not be evaluated with the only one HCV RNA positive participant&#x0D; Conclusion: Although the prevalence of active HCV infection in HIV infected individuals in this study was apparently low (0.5%), screening with HCV antibody test and confirmation with HCV RNA PCR assay are recommended.

Humoral immune response following the inactivated quadrivalent influenza vaccination among HIV-infected and HIV-uninfected adults

BackgroundA limited amount of information is available about the immunogenicity of the quadrivalent inactivated influenza vaccine among human immunodeficiency virus (HIV)-infected individuals, especially in low and middle-income countries (LMICs). MethodsHIV-infected adults and HIV-uninfected adults received a dose of quadrivalent inactivated influenza vaccine including strains of H1N1, H3N2, BV and BY. Enzyme-linked immunosorbent assay (ELISA) and hemagglutination-inhibition assay (HAI) were used to determine IgA, IgG antibody concentration and geometric mean titers (GMT) at day 0 and day 28, respectively. Associated factors contributing to seroconversion or GMT changes were analyzed using simple logistic regression model. ResultsA total of 131 HIV-infected and 55 HIV-uninfected subjects were included in the study. In both HIV-infected and uninfected arms, IgG and IgA against influenza A and B all increased significantly at day 28 after receiving QIV (P < 0.001). GMTs of post-vaccination at day 28 showed that HIV-infected persons with CD4 + T cell counts ≤ 350 cells/mm3 were statistically less immunogenic to all strains of QIV than HIV-uninfected ones (P < 0.05). HIV-infected participants with CD4 + T cell counts ≤ 350 cells/mm3 were less likely to achieve seroconversion to QIV (H1N1, BY and BV) than HIV-uninfected individuals at day 28 after vaccination (P < 0.05). Compared with HIV-infected patients with baseline CD4 + T cell counts ≤ 350 cells/mm3, individuals with baseline CD4 + T cell counts > 350 cell/mm3 seemed more likely to generate antibody responses to H1N1 (OR:2.65, 95 %CI: 1.07–6.56) and BY (OR: 3.43, 95 %CI: 1.37–8.63), and showed a higher probability of seroconversion to BY (OR: 3.59, 95 %CI: 1.03–12.48). Compared with nadir CD4 + T cell count ≤ 350 cell/mm3, individuals with nadir CD4 + T cell count > 350 cell/mm3 showed a higher probability of seroconversion to H1N1(OR: 3.15, 95 %CI: 1.14–8.73). ConclusionInfluenza vaccination of HIV-infected adults might be effective despite variable antibody responses. HIV-positive populations with CD4 + T cell counts ≤ 350 are less likely to achieve seroconversion. Further vaccination strategies could be developed for those with low CD4 T cell counts.

Autonomic Neuropathy as a Predictor of Morbidity and Mortality in People Living with HIV: A Retrospective, Longitudinal Cohort Study (P9-9.006)

<h3>Objective:</h3> This study aimed to evaluate whether HIV-AN is predictive of important adverse clinical outcomes. <h3>Background:</h3> HIV-associated autonomic neuropathy (HIV-AN) is common, however, its clinical impact is unclear. It is known that the composite autonomic severity score (CASS) is associated with markers of morbidity such as the Veterans Affair Cohort Study (VACS) index. Additionally, it is known that cardiovascular autonomic neuropathy due to diabetes is associated with poor cardiovascular outcomes. <h3>Design/Methods:</h3> The electronic medical records of HIV-infected participants who underwent autonomic function tests at the Mount Sinai Hospital between April 2011 and August 2012 were reviewed. The cohort was stratified into those who had no or mild autonomic neuropathy (HIV-AN [-], CASS&lt;/=3) and those with moderate or severe autonomic neuropathy (HIV-AN [+], CASS&gt;3). The primary outcome was a composite of the incidence of death from any cause, new major cardiovascular or cerebrovascular event, or development of severe renal or hepatic disease. Time to event analysis was performed. <h3>Results:</h3> 111 of 114 participants had follow-up data (median follow up for HIV-AN[-] was 94.00 months and HIV-AN[+] was 81.29 months) and were analyzed. Participants were followed until March 1^st, 2020. The HIV-AN[+] group (N=42) was significantly associated with the presence of hypertension, higher HIV-1 viral load, and more abnormal liver function. 17 (40.48%) events occurred in the HIV-AN[+] group, and 11 (15.94%) occurred in the HIV-AN[−] group. 6 (14.29%) cardiac events occurred in the HIV-AN[+] group, whereas 1 (1.45%) occurred in the HIV-AN[−] group. The other subgroups of the composite outcome had a similar trend. The adjusted Cox proportional hazards model showed that the presence of HIV-AN predicted our composite outcome (HR 3.85, CI 1.61–9.20). <h3>Conclusions:</h3> HIV-AN is associated with the development of severe morbidity and mortality in people living with HIV. People living with HIV with autonomic neuropathy may benefit from closer cardiac, renal, and hepatic surveillance. <b>Disclosure:</b> Dr. Kwon has nothing to disclose. Mr. Lawrence has nothing to disclose. Mr. Figueroa has nothing to disclose. The institution of Dr. Robinson Papp has received research support from NIH. Dr. Robinson Papp has received publishing royalties from a publication relating to health care.

HIV-Infected Patients as a Model of Aging.

We appraised the relationship between the biological and the chronological age and estimated the rate of biological aging in HIV-infected patients. Two independent biomarkers, the relative telomere length and iron metabolism parameters, were analyzed in younger (<35) and older (>50) HIV-infected and uninfected patients (control group). In our control group, telomeres of younger patients were significantly longer than telomeres of older ones. However, in HIV-infected participants, the difference in the length of telomeres was lost. By combining the length of telomeres with serum iron, ferritin, and transferrin iron-binding capacity, a new formula for determination of the aging process was developed. The life expectancy of the healthy population was related to their biological age, and HIV-infected patients were biologically older. The effect of antiretroviral HIV drug therapies varied with respect to the biological aging process. IMPORTANCE This article is focused on the dynamics of human aging. Moreover, its interdisciplinary approach is applicable to various systems that are aging.