Iranian HIV-infected Patients Research Articles

Transmitted Drug Resistance Against Integrase Strand Transfer Inhibitors in Iranian HIV-Infected Naïve Patients.

Human Immunodeficiency Virus (HIV) has claimed the lives of millions of people during the past decades. While several antiretroviral drugs like Integrase Strand Transfer Inhibitors (INSTIs) have been introduced to control HIV, Transmitted Drug Resistance (TDR) in HIV genome caused failure in treatment. This study aimed to investigate TDR and natural occurring mutations (NOPs) in HIV integrase gene in Iranian HIV patients. In this cross-sectional study, blood samples of 30 HIV-positive patients who had never taken integrase inhibitors were considered for CD4 T cell count, RT real-time PCR, and, Nested PCR. The sequencing results were analyzed by CLC sequence viewer software and Stanford University HIV Drug Resistance Database. In all samples, nine NOPs with a high prevalence were found; however, we did not find any drug resistance mutations, except for a mutation in one sample, which showed a low resistance level. Subtype A1 was dominant in all samples. Based on the findings and compared to our previous study, all patients were sustainable to main integrase inhibitors, including bictegravir, raltegravir, bictegravir, elvitegravir and dolutegravir. It seems the resistant mutation pattern attributed to integrase inhibitors was not diffent among studied patients; hence, the prescription of such inhibitors helps physicians to control HIV infection in Iranian HIV-infected patients.

Prevalence of Cancers Among Patients with HIV Referring to Voluntary Counseling and Testing Center, Tehran, Iran, 2004-2017

Background: Malignancies, in part, are responsible for high HIV-related morbidity and mortality. While antiretroviral therapy (ART) substantially decreases the risk of developing AIDS-defining cancers, HIV-infected individuals remain at high risk for non-AIDS-defining cancers. Objectives: In Iran, the epidemiology of AIDS and non-AIDS-defining cancers in the HIV-infected population has not been studied; therefore, this study investigated the prevalence of cancers among HIV-infected patients in Iran. Methods: In this cross-sectional study, using convenient sampling, hospital records of 1243 HIV-infected patients from 2004 to 2017 were collected at the Imam Khomeini Hospital in Tehran. The only inclusion criterion was a positive HIV result of ELISA and Western blot tests. The records were investigated for the occurrence of HIV- and non-HIV-defining cancers. To examine the association between relevant factors and cancer, we used a multivariate logistic regression model to calculate the adjusted Odds Ratio (AOR). Results: Thirty-nine out of 1243 HIV-infected patients, including 16 males (41%) and 23 females (59%), were diagnosed with concurrent cancer (3.1%). Twenty-five individuals had AIDS-defining cancers (2%), and 14 had non-AIDS-defining cancers (1.1%). Cervical cancer was detected in 14 patients (1.1%), non-Hodgkin's lymphoma in 7 patients (0.6%), and Kaposi's sarcoma in 4 patients (0.3%). There was a significant association between age group (30-40 years old) and the type of cancer (P = 0.048). Age group (adjusted odds ratio 3.33 for age group ≥ 50 yrs, 95% CI: 0.42-26.60) and gender (adjusted odds ratio 0.36 for men, 95% CI: 0.18–0.70) remained independently associated with cancer (P < 0.05). Conclusions: The prevalence of AIDS-defining cancers was higher than non-AIDS-defining cancers. These results highlighted the importance of promoting cancer screening and early ART initiation among HIV-infected patients.

Gender difference in all-cause mortality of people living with HIV in Iran: findings from a 20-year cohort study.

Gender differences in the efficacy of treatment and the mortality of HIV-infected patients have not yet been fully elucidated. For the first time, we used data from a 20-year cohort of people living with HIV (PLWH) in four provinces (Fars, Bushehr, Bandar Abbas, and Kohgiluyeh and Boyer-Ahmad) in the southern part of Iran to assess the gender difference in all-cause mortality in PLWH in Iran. We analysed data for 1216 patients aged ≥ 15years who were diagnosed with HIV/AIDS between 1997 and 2017. Three hundred and fourteen (25.8%) were women. The death rate from all causes among women was 13.7% vs. 43.8% among men (P<0.001). All-cause mortality was significantly associated with gender [the adjusted hazard ratio (aHR) for men compared with women was 3.20], not being on antiretroviral therapy (ART) compared with being on ART at the last visit (aHR5.42), older age (aHR1.03), delayed HIV diagnosis compared with early diagnosis (aHR1.72), history of incarceration (aHR1.57), higher log CD4 count at diagnosis (aHR0.54), and prophylaxis for Pneumocystis pneumonia (aHR0.09). The results of this 20-year cohort study suggest that gender is an important predictor of survival among HIV-infected patients. Improving early HIV diagnosis and early ART initiation in men, as well as increased access to hepatitis C virus treatment are needed to increase the survival rate of HIV-infected patients in Iran.

Survival Rate of Patients With HIV/AIDS and Related Factors in Tehran, Iran

Background: Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is a major public health problem in Iran. It imposes heavy costs on governments and affected people. Determining the survival duration of patients and recognizing the related factors can help the disease surveillance system. Objectives: The current study aimed at determining the survival rate and the related factors concerning patients with HIV/AIDS identified in Tehran, Iran. Methods: The study population of the current retrospective cohort consisted of patients with HIV/AIDS covered by the Health Center of Southern Tehran. The data were obtained by referring to the HIV/AIDS care centers and reviewing the patients’ records. Survival rates of the study subjects during 10 years follow-up were calculated. The Cox proportional-hazards model was used to determine the relationship between independent variables and survival of patients with HIV/AIDS. Results: A total of 487 patients were investigated in the current study. Four-hundred thirty-three subjects (88.9%) were male, and 54 (11.1%) female. The mean ± standard deviation of the participants’ age was 44.08 ± 9.00 years. According to univariate analyses, the variables of gender, marital status, education level, occupational status, transmission way, infection with hepatitis C or tuberculosis, and history of antiretroviral treatment were significantly associated with the survival time of patients with AIDS. In the final model, a significant relationship was found between the variables of treatment, coinfection with tuberculosis, occupational status, education level, marital status, and mortality. Conclusions: The current study was one of the few research that examined the survival rate of HIV-infected patients in Iran. Considering the expansion of AIDS epidemic in Iran, it is necessary to take appropriate measures to prevent the spread of the epidemic and decrease the mortality rate of infected patients through early detection and timely treatment of HIV-positive people coinfected with tuberculosis, creation of employment opportunities for patients and addicted individuals, controlling substance abuse, and paying more attention to harm reduction programs in individuals that have unsafe sex as one of the most important high-risk groups to increase their survival time.

Prevalence of Microsporidia in HIV-infected Patients in Iran: A Meta-Analysis and Systematic Review

Prevalence of Microsporidia in HIV-infected Patients in Iran: A Meta-Analysis and Systematic Review

Multicenter Cryptococcal Antigen Screening of HIV-Infected Patients in Iran.

Early diagnosis and targeted preemptive antifungal treatment are crucial in reducing cryptococcal meningitis (CM)-related mortality in individuals living with human immunodeficiency virus (HIV). The present study was performed to determine cryptococcal antigenemia and outcomes among HIV-infected patients in Iran. This multicenter prospective study was conducted between October 2016 and December 2018. For the purpose of the study, blood samples were randomly collected from 177 profoundly immunosuppressed (CD4+ counts < 200 cells/µL) HIV-positive individuals in six major cities of Iran. The patients were antiretroviral therapy-naive or had received inadequate medication. The stored sera were screened for cryptococcal antigen (CrAg), using point-of-care lateral flow assay (IMMY® diagnostics, Norman, OK, US). Overall, out of the 174 asymptomatic patients, 3 (1.72%) cases were CrAg-positive using the LFA in serum. Accordingly, the prevalence of cryptococcal antigenemia was 7.14%, 0%, and 1.2% in the patients with the CD4+ counts of < 50, 50-100, and 100-200 cells/μL, respectively. The median age of the patients with antigenemia was 36years (age range 8-55years). The median CD4+ count of the cohort was 98 cells/μL (range 14-200 cells/μL). Routine screening of Iranian HIV-infected patients with CD4+ count of < 50 cells/µL beforeinitiating antiretroviral therapy is justified. It is suggested to conduct more inclusive research throughout the whole country on more patients to recommend screening cryptococcal antigen strongly.

Prevalence of Hcv and/or Hbv Coinfection in Iranian HIV-infected Patients

Aim: HIV-infected patients risk coinfection with HBV and HCV. This study aimed to investigate molecular epidemiology of HBV and HCV coinfection in Iranian HIV-infected individuals. Materials & methods: In this cross-sectional study, serological markers of HBV and HCV infection (hepatitis B surface antigen [HBsAg], hepatitis B e-antigen [HBeAg], hepatitis B e-antibody [HBeAb] and hepatitis B core antibody [HBcAb]) and anti-HCV antibodies [anti-HCV Abs] were tested in 198 Iranian HIV-infected patients. From plasma, HBV viral load was determined using COBAS TaqMan 48, and HCV-RNA was detected by reverse transcriptase-nested PCR. Results: 85 out of 198 (42.9%) patients were anti-HCV Ab positive and 42/198 (21.2%) had detectable HCV-RNA. Eight (4.0%) had traceable HBV-DNA. All these patients were infected by HBV genotype D. 55 (27.8%) were HBcAb positive. Nine (4.4%) were HBsAg and anti-HCV Ab positive. Conclusion: None were HIV-RNA/HCV-RNA/HBV-DNA positive, 21.2% were HIV-RNA/HCV-RNA positive and 4.0% were HIV-RNA/HBV-DNA positive. Therefore, studies on diagnosing these infections in HIV-infected individuals may be valuable.

HIV drug resistance among naïve HIV-infected patients in Iran.

Background:Antiretroviral (ARV) therapy extends life for persons living with HIV. Antiretroviral treatment (ART) has been rapidly expanding coverage around the world, including in Iran. However, ART drug resistance also rapidly develops with expanding use and limits effectiveness and treatment options. The aim of this study was to monitor the appearance of new mutations conferring HIV pretreatment drug resistance in the treatment of naïve patients with HIV in Iran.Materials and Methods:Blood samples were obtained from ARV treatment-naïve patients from 8 different provinces in Iran in 2016 for genotyping for drug resistance mutations.Results:Sequences were successfully obtained from 90 specimens. Of these, 2 (2%) mutations conferring resistance to protease inhibitors, 2 (3%) conferring resistance to nucleoside reverse transcriptase inhibitors (NRTIs), and 9 (13%) conferring resistance to non-NRTI (NNRTI) were detected. Any ARV-resistant drug mutation was found in 11 patients (12%).Conclusion:Nearly one in 8 ARV-naïve patients had mutations associated with NNRTI resistance in diverse areas of Iran in 2016. Iranian ARV therapy guideline for HIV could consider non-NNRTI-based first-line therapies and expand routine drug resistance testing before treatment initiation as according to HIV drug resistance recommendations of the World Health Organization.

Predictors of HIV-Preventive Behavior Changes Among HIV-Infected Patients in Iran: Application of the Extended Health Belief Model

Background: One mode of HIV transmission is through the high-risk behaviors among people who are HIV-positive. It is, therefore, exceedingly important to understand the factors predicting preventive healthy behaviors regarding HIV transmission in this population. Objectives: The aim of this study was to evaluate the efficacy of the extended health belief model (HBM) in predicting preventive behavior changes among HIV-infected patients in Iran. Methods: In a cross-sectional study, the census sampling was applied and 139 HIV-positive patients in Saravan, Zarandieh, and Sarbaz cities of Iran were selected to participate in this study. In total, 131 participants completed and returned the anonymous self-administered questionnaires in 2016. The questionnaire included demographic questions, HBM (HBM) constructs, and the questions of Zimet social support. Data analysis was performed using SPSS18. P-values less than 0.05 were considered significant. Results: The HBM constructs with and without social support accounted for 62% and 56% of the behavior variance, respectively. In the first model (HBM construct alone), perceived barriers, self-efficacy, and benefits were the significant predictors. In the second model (HBM developed with social support), perceived barriers, social support, self-efficacy, and benefits were the better predictors of preventive behaviors, in sequence (P < 0.05). Conclusions: The findings indicated that the extended model of HBM predicted preventive behaviors better than the original HBM did. However, more studies are needed to examine the efficacy of the extended HBM in predicting preventive behaviors. Keywords: AIDS; Health Belief Model; HIV; Social Support

Impact of HIV risk factors on survival in Iranian HIV-infected patients: A Bayesian approach to retrospective cohort

Impact of HIV risk factors on survival in Iranian HIV-infected patients: A Bayesian approach to retrospective cohort

Hepatitis E Virus Seroprevalence and Viremia in Hemodialysis and HIV Infected Patients in Iran

Hepatitis E Virus Seroprevalence and Viremia in Hemodialysis and HIV Infected Patients in Iran

Effect of Food Insecurity on the HIV Progression among the HIV-infected Patients in Iran

Effect of Food Insecurity on the HIV Progression among the HIV-infected Patients in Iran

Mechanisms of resistance to fluconazole in Candida albicans clinical isolates from Iranian HIV-infected patients with oropharyngeal candidiasis

The opportunistic pathogen Candida albicans is the major agent of oropharyngeal candidiasis (OPC) in HIV/AIDS patients. The increased use of fluconazole can lead to the emergence of azole-resistant strains and treatment failures in PLWH (people living with HIV) receiving long-term therapy for OPC. The purpose of this study was to evaluate CDR1, CDR2, MDR1, and ERG11 gene expression in C. albicans clinically isolated from HIV-infected patients in Iran. In this study, we evaluated the molecular mechanisms of azole resistance in 20 fluconazole-resistant C. albicans isolates obtained from Iranian HIV-infected patients with oropharyngeal candidiasis by Real-Time polymerase chain reaction. The overexpression of drug efflux pump CDR1 gene was found to be the major resistance mechanism observed in these isolates. The overexpression of the CDR1 gene correlated strongly with increasing resistance to fluconazole (P<0.05). Additionally, an increased level of mRNA in ERG11 was not observed in any of the tested isolates. Our findings suggested that the CDR1 gene expression to fluconazole resistance in C. albicans is greater than other known genes.

Utility of QuantiFERON-TB Gold In-Tube Test in the Diagnosis of Latent TB in HIV-Positive Patients in a Medium-TB Burden Country.

The authors aimed to compare TST with QuantiFERON-TB Gold In-Tube (QFT) for detecting latent tuberculosis infection (LTBI) in HIV-infected patients in Iran as a TB-medium endemic country. In a cross-sectional design,130 HIV-positive patients in HIV clinic of Tehran University were studied. Patients screened for LTBI with QFT and TST simultaneously. Concordance between 2 tests results and variables associated with tests discordance were assessed. Positive results found in 24.6% for TST and 7.7% for QFT. Overall agreement between them was 73.85% (Kappa = 0.083). History of imprisonment was associated with more positive TST (P = 0.014) and QFT (P = 0.01). Patients with intravenous drug use (IDU) history had significant discordant results (0.018). The authors recommend QFT for all negative cases of TST in HIV-positive patients especially who had history of IDU.

Neurological manifestations in HIV positive patients in Tehran, Iran

ObjectiveTo evaluate the neurological complications among Iranian HIV-positive patients. MethodsThis cross-sectional study was conducted among 428 patients diagnosed with HIV infection between 2006 and 2009 at Imam Khomeini hospital, Tehran, Iran. Demographic and clinical variables as well as laboratory tests were extracted and analyzed. Also, another 100 patients refereed to Voluntary Counseling and Testing center of the hospital were visited and evaluated for neurological complications. ResultsAmong the patients, neurologic manifestations were observed in 34 (7.94%) patients. Twenty three percent of the patients received antiretroviral therapy. Identified causes included brain toxoplasmosis (14.7%), progressive multi-focal leuko encephalopathy (5.9%), HIV encephalopathy (5.9%), TB meningitis (5%) and unknown etiologies (11.8%). Also, among 100 patients who were admitted and visited at the Voluntary Counseling and Testing center, no one was diagnosed for any neurological manifestations. ConclusionsAccording to our results, toxoplasmosis is the most frequent cause of neurological conditions among Iranian HIV infected patients and should be considered in any HIV/AIDS patient with neurological manifestations.

Serum Vitamin D Concentration and Potential Risk Factors for its Deficiency in HIV Positive Individuals

Human immunodeficiency virus (HIV) infected individuals are prone to malnutrition, and deficiencies of some minerals and vitamins. The aim of this study is to evaluate the frequency of vitamin D deficiency and determine the possible risk factors associated with this problem in HIV-infected individuals. This cross-sectional study was performed on 98 adult patients referred to the Emam Khomeini Hospital Complex, Tehran, Iran. The patients' serum vitamin D concentration was determined using radioimmunoassay method. The possible correlations between demographic and clinical data with the level of vitamin D were evaluated. Vitamin D levels less than 35 nmol/l were considered as deficient in this study. Eighty-five (86.7%) of the patients had serum vitamin D deficiency (concentrations less than 35 nmol/l) in this study. Coinfection with hepatitis C virus (HCV) was present in 54 (55.1%) of the patients. Only daily intake of vitamin D (r = 0.304, p = 0.002), duration of sun exposure (r = 0.268, p = 0.009), the level of PTH (r = -0.459, p < 0.001), daily intake of calcium (r = 0.239, p = 0.018) and GFR of more than 90 ml/min (OR = 1.208, CI 95% = 1.080-1.350, p = 0.033) had a correlation with serum vitamin D concentration. Being female (OR = 7.224, CI 95% = 3.640-14.335, p < 0.001), unemployed (OR = 1.627, CI 95%= 1.209-2.190, p < 0.001) and infected with HCV (OR = 1.811, CI 95% = 1.331-2.465, p < 0.001) were related to the severe serum vitamin D deficiency. Vitamin D deficiency is a common problem in Iranian HIV-infected patients and with concern of this vitamin's important role in health issues, early evaluation of its status and providing appropriate nutritional support seems to be important.

Prevalence of Cardiac Manifestations in HIV-Infected Patients in Iran

Prevalence of Cardiac Manifestations in HIV-Infected Patients in Iran

Assessing subtype and drug-resistance-associated mutations among antiretroviral-treated HIV-infected patients

Several studies have reported an increasing number of therapeutic failures with antiretroviral drugs in HIV-infected patients. The emergence of viral-resistant strains is a major problem for the medical management of infected individuals. The aim of this study is to determine viral subtypes and drug-resistance mutations among antiretroviral-treated HIV-infected patients. A total of 42 antiretroviral-treated but still viremic HIV-infected patients were enrolled. The HIV pol regions were amplified and sequenced to determine subtypes and antiretroviral-resistant mutations. The subtype distribution was 48% A/D recombinants, 43% subtype B, 5% subtype A and 5% CRF01-AE recombinants. Drug-resistant mutations were most common in subtype B (53%) and A/D recombinant strains (44%). Virus samples from 19% of participants had no drug-resistant mutations; 2, 2 and 76% of samples carried one, two and at least three drug-resistant mutations, respectively. The prevalence of nucleoside transcriptase inhibitor mutations was 76%, with M184V and L74V present in 60 and 38% of samples, respectively. The prevalence of nonnucleoside transcriptase inhibitor mutations was 74%, with P225H present in 55% of study specimens. The prevalence of protease inhibitor mutations was 45%, with major mutation L90M seen in 33% and minor mutation A71V in 36% of samples. Of note, the P225H and A71V are 'minor' drug-resistance mutations conferring only minimal drug-resistance phenotypes in the absence of major mutations. Our study found a high prevalence of drug-resistant mutations in Iranian HIV-infected patients. Our data support the need for continued surveillance of resistance patterns to help guide therapeutic approaches and limit transmission of these variants.

Occult Hepatitis B Virus Infection in HIV-Infected Patients with Isolated Hepatitis B Core Antibody

Objective: Detection of hepatitis B virus (HBV) DNA without detectable hepatitis B surfaceantigen (HBsAg) is defined as occult HBV infection. In patients co-infected with human immunodeficiency virus (HIV) and HBV, HIV interferes with the natural history of HBV infection by enhancing HBV replication, leading to more severe liver disease. The aim of this study was to assess occult HBV infection in Iranian HIV-positive patients with isolated hepatitis B core antibody (anti-HBc). Methods: The presence of HBV-DNA was determined quantitatively in plasma samples of HIV-infected patients with isolated anti-HBc by real-time PCR using the artus HBV RG PCR kit on the Rotor-Gene 3000 real-time thermal cycler. Hepatitis C antibody (anti-HCV), alanine aminotransferase (ALT), aspartate aminotransferase (AST), HIV viral load and CD4+ count were also tested in all subjects. Results: Of 106 patients enrolled in this study, 22 subjects (20.75%, 95% CI 13–28) had isolated anti-HBc. HBV-DNA was detectable in 3 of the 22 patients (13.6%, 95% CI 0.0–28) who had isolated anti-HBc. Conclusion: A serological profile of isolated anti-HBc could be associated with occult HBV infection in Iranian HIV-infected patients. Therefore the risk of transmission of HBV is probable in these patients.

Assessment of the Factors Involving in the Development of Hypothyroidism in HIV-infected Patients: A Case-Control Study

Increased prevalence of thyroid dysfunction has been reported in HIV-infected patients, and recent studies have shown hypothyroidism as the most common thyroid function abnormality in this population, especially after treatment with antiretroviral drugs (HAART). The aim of this study is to assess risk factors of hypothyroidism in HIV-infected patients in Iran. This case-control study was conducted among 15 hypothyroid (cases) and 70 euthyroid (control group) HIV-infected outpatients. Serum Free T4, Free T3, and TSH levels were measured, and data on age, sex, body mass index, opium addiction or injection of illicit drugs, duration of HIV infection and HAART, disease stage, CD4-cell count, opportunistic infection (OI) or malignancy, HCV co-infection, and drug use were collected. We found no association between hypothyroidism in HIV-infected patients and any parameters measured, and P value was not significant for receipt of HAART (0.141), CD4-cell count (0.094), duration of HIV infection (0.474), duration of HAART (0.418), HCV co-infection (0.146), OI (0.566), or receipt of rifampin (0.816). In this study, age, sex, HAART, mean CD4- cell count, duration of HIV infection, HCV co-infection, and OI were not significant risk factors of hypothyroidism in HIV-infected patients. The occurrence of hypothyroidism may be related to other factors or HIV infection itself. Therefore, hypothyroidism should be considered in all HIV-infected patients.