HIV-infected Persons Research Articles

High seroprotection rates and geometric mean titre increases after repeated annual influenza vaccinations in a cohort of HIV-infected adults in Austria

IntroductionVaccination against seasonal influenza is recommended for all HIV-infected persons. Few data have been reported on the effect of repeated annual vaccination in this population. MethodsWe measured haemagglutination inhibition antibody responses and investigated seroprotection rates in 344 HIV-infected adults before and 12 weeks after influenza vaccination with a trivalent subunit vaccine. Results68.3% of patients were male, the median age was 45 years. 83.7% had a viral load < 50 copies/mL. The median CD4 count was 604/µL. 304 patients (88.4%) had received influenza vaccinations in previous years. Seroprotection rates for A/H1N1 and B were over 90% in all age groups before vaccination and close to 100% after vaccination. For A/H3N2, seroprotection rates were lowest in individuals below 30 years both before and after vaccination (22.2% and 50.0%) and higher in older age groups (48.4% and 83.9% in people over 60 years). GMT fold increases were not significantly different across the age groups (3.0 to 4.2, p = 0.425). Previous influenza vaccinations were associated with higher seroprotection rates before and after vaccination (62.2% and 84.2% in patients with 8 or more previous vaccinations vs. 15.0% and 57.5% without previous vaccinations, respectively). Individuals with detectable viral load, elevated immune activation (urine neopterin ≥ 250 µmol/mol creatinine), and higher CD4 nadir (≥200 cells/µL) showed a trend towards inferior immune responses to vaccination, whereas gender and CD4 count did not have an effect. ConclusionThe lower seroprotection rates observed in younger individuals may be explained by the higher proportion of patients without HIV treatment and with fewer previous encounters with influenza strains. Good seroprotection rates can be achieved in elderly HIV-infected patients and after repeated annual vaccinations.

Prevalence of hepatitis B and D viruses in HIV-infected persons in the Socialist Republic of Vietnam

The aim of this study was to estimate the prevalence of hepatitis B and D viruses among HIV-infected residents of South Vietnam.Materials and methods. The study material was represented by 316 blood serum samples collected from HIV-infected residents of the Socialist Republic of Vietnam taking antiretroviral therapy. The subjects were examined for the presence of HBV markers with a qualitative detection of HBsAg, HBs IgG, HBcore IgG, anti-HDV, DNA HBV, and RNA HDV. HBV and HDV complete genomes nucleotide sequences were obtained for 23 samples from HIV+HBV+HDV co-infected patients. Amplification and subsequent sequencing of HBV and HDV were performed using nested PCR with pair’s overlapping primers jointly flanking the complete HBV and HDV genomes, respectively.Results. Serological markers of HBV and HDV were presented in the following ratios: HBsAg — 9.17%, anti-HBs Ig G — 10.44%, anti-HBcore Ig G — 42.08%, total anti-HDV — 9.81%. HBV DNA was detected in 32.58% of cases, including 23.41% of HBsAg-negative individuals. HDV RNA was detected in 24.13% of HBsAg-positive individuals and 21.62% of HBsAg-negative, which amounted to 22.33% of HBV-positive individuals and 7.27% of the total group, respectively. In phylogenetic analysis, HBV subgenotype B4 (60.89%) prevailed among HIV-infected patients compared to C1 (21.73%), B2 (8.7%), C2 (4.34%) and C5 (4.34%). Phylogenetic analysis of HDV nucleotide sequences showed the prevalence of HDV genotype 1 (78.26%) compared to genotype 2 (21.74%). The hepatitis Delta virus prevalence in patients with HIV+HBV coinfection, and the prevalence of seronegative HDV in patients with OBI indicate the need to use PCR in hepatitis highly endemic regions for hepatitis B and hepatitis D screening of the general population and especially those at-risk groups.

COVID-19 Clinical Presentation Among HIV-Infected Persons in China: A Systematic Review.

Purpose of ReviewThe impact of HIV infection on the natural history of COVID-19 is unknown, given the recency of the human spread of SARS-CoV-2 (CoV). We reviewed published case series/reports of CoV-HIV coinfections to clarify epidemiologic and clinical features in China, the first nation with pandemic experience.Recent FindingsAssuming that HIV-infected persons were at average risk of CoV infection in Wuhan, we estimated HIV-CoV coinfected persons to number 412 (95%CI: 381-442); our review encompassed an estimated 16.7% (69/412) of Wuhan. Men (many of whom reported sex with other men) accounted for 71.1% (54/76) of the cases reported in China. The median age was 48.0 years old (range 24-77, interquartile:37-57). The median CD4+ cell count at the last clinical visit was 421 cells/μL; 83.0% had an undetectable viral load. Among 31 patients with clinical details reported, fatigue (41.9%), respiratory distress (41.9%), and gastrointestinal symptoms (26.7%) were most common. Among the 52 cases reporting COVID-19 clinical severity, 46.2% were severe, 44.2% mild, and 9.6% asymptomatic COVID-19. Late antiretroviral therapy (ART) was reported by 30.4% (7/23) among whom 57.1% (4/7) were confirmed as severe COVID-19. The case fatality rate was 9.1% (3/33). Severe disease and death were less common among persons who took ART prior to the COVID-19 diagnosis. Of 16 reported IL-6 results, 68.7% were within the normal range.SummaryEarlier use of ART was associated with a better COVID-19 prognosis with CoV-HIV co-infection reported from China through early 2021, but small sample sizes limit definitive conclusions.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11904-022-00606-0.

Hematological responses of HIV-seropositive patients to aerobic and resistance exercise training programs

This study investigated the alterations of haematologic parameters of HIV-positive patients due to a 10-week aerobic and resistance exercise training. The study examined the influence of aerobic and resistance exercises on White Blood Cells (WBC), Red Blood Cells (RBC), Haematocrit (HCT), and Platelets (PLT). The pretest-posttest control-group experimental design was employed in this study. Eighty-eight HIV-seropositive patients in the first two stages of HIV and attending the outpatient clinic at the University of Benin Teaching Hospital participated in the study. Randomization was done into control (30) and two experimental groups, aerobic exercise (28) and resistance exercise (30). The experimental groups exercised for 45 minutes, thrice a week for 10 weeks and the non-experimental group received usual anti-retroviral drugs and counseling. The initial intensity of the exercise was 60% HRmax and 1-RM and progression was by 10% every 3 weeks. Haematologic parameters were recorded initially and on termination of 10 weeks for all three groups. Frequency, mean, standard deviation, and analysis of co-variates (ANCOVA) were used for data analysis. The Bonferroni pairwise comparison was used as a Post-hoc test to identify the source of differences. The outcome of this research showed that exercise resulted in significant alterations in haematologic parameters of WBC, RBC, HCT, and PLT. Recommendations were made based on the outcome of this research that health personnel should prescribe exercise for HIV-infected persons due to the enhancement of haematologic parameters which in turn improves health.

Duration of HAART use: A key prognosticator for NAFLD in HAART experienced HIV patients

Background: The Human immunodeficiency disease (HIV) remains a global menace decades after its discovery and despite advances in therapeutics and use of Highly active antiviral therapies (HAART). HIV/AIDS patients now have longer lifespan with increased non-AIDS related morbidity and mortality. Non-alcoholic fatty liver diseases (NAFLD), a global public health challenge has been identified as one of the leading causes of morbidity and mortality in HIV infected persons. Our study aimed to identify the risk factors for NAFLD in HIV infected patients and to relate the liver enzymes derangement to NAFLD. Method: we retrospectively analyzed data from 170 HAART experienced viral hepatitis sero-negative HIV patients. Sociodemographic, anthropometric, and laboratory characteristics were extracted. Hepatic steatosis was diagnosed by ultrasound scan. Result: NAFLD was present in 27.9% of the patients and the duration of HAART use (p&lt;0.001), elevated plasma glucose level (p&lt;0.001), increased waist circumference (p=0.004), duration of HIV infection (p=0.026), and elevated serum triglycerides (p=0.033) were identified as the major risk factors for NAFLD. Using the Wald test of variables, duration of HAART use was identified as the key prognosticator of NAFLD in HIV patient [Wald value (WV) of 10.749 (p= 0.001)]. Reduced CD4 cell count and liver enzyme derangement were not identified as risk factors for NAFLD. Conclusion: NAFLD is common in HAART experienced HIV patients and the duration of HAART use is the most important predictor for its occurrence. Early recognition and vigorous modification of these risk factors among HIV patients are necessary to prevent further progression of NAFLD.

Delays in Cryptococcal Meningitis Diagnosis and Care: A Mixed Methods Study in Rural Uganda.

Background:Cryptococcal meningitis (CM) remains a major cause of mortality for HIV-infected persons in sub-Saharan Africa, despite widespread access to antiretroviral therapy. Delays in CM diagnosis and treatment contribute to high mortality, with patients often arriving “too late” for treatment to be effective. Little is known about patient-related delays and their experiences with CM.Objectives:This study seeks to identify the factors related to delays in diagnosis and care among patients with cryptococcal meningitis.Methods:A convergent mixed-methods approach was used to understand delays related to diagnosis and treatment of CM among patients admitted to Lira Regional Referral Hospital in rural northern Uganda. We collected data from February to March 2020 using surveys followed by semi-structured interviews from 20 CM patients who survived hospitalization and 20 family members of deceased patients during February 2017–November 2019. Interviews were audio-recorded, transcribed, and thematically coded for analysis.Findings:Delays to CM care were related to 1) self-medication, 2) lack of CM education, 3) seeking treatment multiple times at health centers with 4) missed/misdiagnosis, and 5) cultural factors. Among patients who died, 70% sought care ≥3 times, while those who survived, 35% of sought care ≥3 times before CM diagnosis. Only 10% of patients and 40% of family members knew what caused CM, indicating a lack of knowledge.Conclusions:Patients sought medical care for CM symptoms, but several factors contributed to CM diagnosis and care delays. Many of these factors relate to a lack of CM education and knowledge among patients and providers. A CM awareness campaign for the general public, targeted education for HIV patients, and continuing medical education for healthcare providers can decrease delays and improve outcomes.

Acute hepatitis B among HIV positive persons: A two-decade review of cases from a Spanish cohort

PurposeTo review the incidence and characteristics of acute hepatitis B (AHB) in a large cohort of HIV infected persons from a low prevalence region during the last two decades. MethodsRetrospective review of an HIV Cohort from a single reference centre in Madrid, Spain, between 2000 and 2018. AHB was diagnosed in persons with newly acquired HBAgS and acute hepatitis with positive IgM anti-HBc. ResultsOut of 5443 HIV+ patients in our cohort (3098 anti-HBc negative), 18 developed AHB from 2000 to 2018. The global incidence was 0.02 (0.01–0.04) per 100 patient-year in the entire population and 0.06 (0.01–0.1) per 100 patient-year in the anti-HBc negative population. A statistically significant decrease in AHB incidence was observed during these years (β=−0.006; p=0.047).All 18 patients diagnosed with AHB were men, the majority (16) occurred in men who have sex with men. AHB was observed in 4 persons previously unresponsive to vaccination. Regarding antiretroviral treatment (ART), 15 were not receiving ART, two persons were on ART with any HBV active drugs and one person had lamivudine in the regimen. Two persons (11%) developed chronic hepatitis B. There were no cases of fulminant hepatitis. ConclusionThe incidence of AHB in HIV positive persons in our cohort was low and shows a progressive decline in the last 20 years. Cases occurred in persons not protected against VHB: not vaccinated or non-responders to vaccine that were not receiving tenofovir.

AIDS at 40th: The progress of HIV treatment in Japan.

Forty years have passed since the first five AIDS cases in Los Angeles were reported in 1981. Looking back at the history, these 40 years could be divided into 3 phases. During the first 15 years, when there was little efficacious therapy against HIV, clinical research was directed to develop diagnosis and treatment for opportunistic infections, mainly Pneumocystis jirovecii pneumonia. When combination antiretroviral therapy (cART) became available in 1996, taking cART had been troublesome to most patients following 10 years because some of them had severe side effects, diet restrictions, high pill burdens, drug interactions, etc. It was not easy for patients to keep high adherence and, therefore, the virus easily obtained drug resistance. Although the prognosis has been dramatically improved, patients had been still living with hard times during the second phase. Along with advancement of anti-retroviral drugs that have allowed simple treatment possible, their life expectancy has further improved and is reaching almost nearly the general population in the following 15 years. However, some patients have recently faced an additional load to treat life-related comorbidities and non-AIDS defining malignancies. The problem is that these diseases start to occur in the 40s- or 50s-year-old generations and that means HIV-infected persons are suffering from pre-mature aging. AIDS no longer signifies death. However, we still have a lot to improve for their quality of life.

The results of a comparative analysis of the population of the population of Ukraine and countries of the European region for HIV as a rationale for improving the pharmaceutical provision of patients with socially dangerous pathologies

The aim: to conduct a comparative analysis of HIV morbidity in Ukraine and in some countries of the European region over the years and to determine the characteristics of the epidemiological situation on this pathology.&#x0D; Materials and methods. The object of the study was HIV incidence data presented on the website of the WHO European Health Portal (1990–2018) and in the Annual Report of the European Center for Disease Prevention and Control and the WHO Regional Office for Europe on HIV/AIDS Surveillance in Europe (2010–2019). Historical, analytical-comparative, systemic, graphic, logical, hypothetical-deductive, mathematical-statistical, epidemiological and other research methods were used.&#x0D; Results. It is established that during 1990-2018 in the group of reference countries only for Ukraine and Belarus there was a significant fluctuation in the incidence rates presented in absolute data. In all countries except Romania, the number of HIV-infected in 2019 was higher than in 1990 (Ukraine, Belarus, Poland) and in 1993 (Germany). Analysis of the dynamics of the absolute number of HIV-infected persons by indicative years (1993, 1999, 2004, 2010, 2016, 2019) allows us to assert the different nature of changes in epidemiological data by group of reference countries. Only in Poland we saw a gradual increase in data for 1993-2019. In all other countries, there was a complex nature of changes in morbidity. According to the analysis of HIV incidence, presented in relative terms, it was found that they ranged in the largest range in Belarus, namely from 11.3 (2010) to 26.1 (2017). Belarus typically had the highest mean chain growth/decline rates of HIV incidence (1.09). In turn, the lowest value of these coefficients was observed in the EU as a whole (0.97). Comparison of average values of HIV incidence per 100 thousand population suggests that in Ukraine this figure was 1.85 times higher than in Belarus, 11.36 times higher than in Poland, 8.65 times higher than in Romania, 10.27 times higher than in Germany and 5.88 times more than in the EU group.&#x0D; Conclusions. The presence of a complex and tense epidemiological situation with HIV infection in Ukraine in comparison with other countries of the reference group of countries suggests the need to implement comprehensive programs to counter the spread of this socially dangerous infection and introduce models for the rational use of limited health care resources and international funds

The Role of Innate Immunity in Natural Elite Controllers of HIV-1 Infection.

The natural process of human immunodeficiency virus type 1(HIV-1) infection is characterized by high viral load, immune cell exhaustion, and immunodeficiency, which eventually leads to the stage of acquired immunodeficiency syndrome (AIDS) and opportunistic infections. Rapidly progressing HIV-1 individuals often die of AIDS several years after infection without treatment. The promotion of ART greatly prolongs the survival time of HIV-infected persons. However, some patients have incomplete immune function reconstruction after ART due to latent storage of HIV-infected cells. Therefore, how to achieve a functional cure has always been the focus and hot spot of global AIDS research. Fortunately, the emergence of ECs/LTNPs who can control virus replication naturally has ignited new hope for realizing a functional cure for AIDS. Recently, a special category of infected individuals has attracted attention that can delay the progression of the disease more rigorously than the natural progression of HIV-1 infection described above. These patients are characterized by years of HIV-1 infection, long-term asymptomatic status, and normal CD4+T cell count without ART, classified as HIV-infected long-term nonprogressors (LTNPs) and elite controllers (ECs). Numerous studies have shown that the host and virus jointly determine the progression of HIV-1 infection, in which the level of innate immunity activation plays an important role. As the first line of defense against pathogen invasion, innate immunity is also a bridge to induce adaptive immunity. Compared with natural progressors, innate immunity plays an antiviral role in HIV-1 infection by inducing or activating many innate immune-related factors in the natural ECs. Learning the regulation of ECs immunity, especially the innate immunity in different characteristics, and thus studying the mechanism of the control of disease progression naturally, will contribute to the realization of the functional cure of AIDS. Therefore, this review will explore the relationship between innate immunity and disease progression in ECs of HIV-1 infection from the aspects of innate immune cells, signaling pathways, cytokines, which is helpful to provide new targets and theoretical references for the functional cure, prevention and control of AIDS, and development of a vaccine.

Voluntary HIV Counselling and Testing Amongst Trainee Nurses and Midwives in Ghana and their Perception of Disclosure of HIV Positive Status to Partners

Voluntary Counseling and Testing (VCT) is the best strategy for a successful HIV prevention, care, and support service implementation among HIV-negative and positive individuals. VCT is also recognized as a critical component in the reduction of risk among sexually active young people. This study aims to assess the voluntary HIV counseling, testing, and utilization amongst student nurses and midwives in Ghana and their perception of the disclosure of HIV-positive status to partners. This study used a cross-sectional quantitative descriptive survey amongst 98 nursing and midwifery students at the Nursing and Midwifery Training College, Koforidua. A simple random sampling was used in selecting the participants. Data collection was done using a structured questionnaire. Females dominated the study with the majority of respondents being single. VCT uptake among the respondents was low. Only 26.5% had ever undertaken VCT. It was observed that their willingness to accept VCT does not translate into actual testing. The majority (83%) of respondents perceived that HIV-infected persons should disclose their status to a sexual partner. Fear of stigma (96.0%), fear of loss of friends (98.0%), and fear of being abused (88.8%) were identified as the barriers to HIV status disclosure. To promote VCT services among trainees, these services need to be periodically included in school activities. A comprehensive VCT training module needs to be included in the school curriculum. More emphasis should be placed on the benefits of VCT so that students will understand the importance of implementing VCT services.

Seronegative Infection with Toxoplasma gondii in Asymptomatic Human Immunodeficiency Virus Type 1 (HIV-1)-Infected Patients and in Blood Donors.

Background: Toxoplasmosis is a common opportunistic infection in AIDS patients. The routine diagnostics is based on serologic testing and IgG avidity index, but it may have limited utility in immunodeficient patients; thus, it is recommendable to detect T. gondii DNA in subjects with advanced HIV disease. The results of the studies published so far focused on patients with clinical symptoms of toxoplasmosis. Our study encompassed a group of HIV-infected subjects on cART therapy, without immunological disturbances and clinical symptoms of T. gondii infection. Methods: The study was retrospective, and samples were collected between 2013 and 2016. We evaluate the prevalence of serological (IgM, IgG, and avidity IgG) and molecular (DNA) T. gondii infection markers in asymptomatic HIV-infected patients and the control group using serologic (ELISA) and quantitative (real-time PCR) molecular testing. Results: Of 152 HIV-infected in routine follow-up tested for T. gondii IgM and IgG, 6 (3.9%) and 50 (32.9%) were positive, respectively. Of 168 serum samples from blood donors, 1 (0.6%) and 49 (29.2%) were IgM+ and IgG+ positive, respectively. IgM seroprevalence in HIV-infected patients was significantly higher than in blood donors. T. gondii DNA (genotype II) was identified in 47 (30.9%) HIV-infected patients, with 13 (8.6%) IgM−IgG− samples. In blood donors, T. gondii DNA was present in 15 (8.9%) IgM−IgG−. Conclusions: In both groups, T. gondii DNA was detectable in seronegative subjects, implying the need to supplement the routine serological testing via the molecular method. It can help the accurate monitoring of the reactivation of infection in asymptomatic HIV-infected persons, and the quick introduction of specific therapy, in blood donors, would be of high importance for safe blood donations.

Структурно-системний моніторинг інформованості різних верств населення щодо діагностики, профілактики та лікування ВІЛ/СНІДу

У роботі наведено аналіз епідеміологічної ситуації з ВІЛ/СНІДу в Дніпропетровській області, а також результати соціально-психологічного дослідження різних соціальних груп населення даного регіону. Дослі­дження проведені шляхом анкетування 99 жителів. Було виявлено, що населення Дніпропетровського регіону в цілому досить орієнтоване в більшості питань, що стосуються проблем ВІЛ/СНІДу, проте значна частина (в тому числі і медичні працівники) демонструє нетерпимість до людей, які живуть з ВІЛ. Відзначено наявність стигматизації та дискримінації, а також недостатню інформаційну активність і соціальну підтримку з боку громадських організацій, що працюють в Дніпропетровській області. Також виявлено поширення СНІДофобії у 72 % жителів міста, які прийшли на прийом у поліклініку (група А), і у 24 % медпрацівників різних спеціальностей (група Б). У свою чергу, 40 % респондентів групи А і 12 % респондентів групи Б вважають за необхідне ізоляцію ВІЛ-інфікованих від суспільства, що підтверджує недостатню інформованість населення з питань ВІЛ/СНІДу. Аналіз отриманих даних показав, що більшість ВІЛ-інфікованих громадян не вважають за необхідне навіть за наявності факторів ризику проходити обстеження на ВІЛ до появи серйозних проблем зі здоров’ям, тим самим є прихованим джерелом інфекції, що підтримує поширення ВІЛ. На це вказує той факт, що тільки у 33 % респондентів групи людей, які живуть з ВІЛ, статус інфікування виявлено саме завдяки анонімному тестуванню.

Зміни імунологічного статусу у ВІЛ-інфікованих осіб із хронічною токсоплазмозною інвазією та токсоплазмозним енцефалітом

Актуальність. Інвазія Toxoplasma gondii у ВІЛ-інфікованих осіб може призвести до поглибленої імунопатології, що сприяє реактивації брадизоїтів та розвитку тяжких опортуністичних захворювань. Мета дослідження: вивчити особливості імунологічного статусу ВІЛ-інфікованих пацієнтів, які інвазовані токсоплазмами, та визначити предиктори розвитку токсоплазмозу мозку. Матеріали та методи. Обстежено 61 ВІЛ-інфіковану особу (33 особи серопозитивні на токсоплазмоз і 28 — серонегативні). Застосовували імуноферментний метод для визначення титрів специфічних протитоксоплазмозних IgG та IgМ; загальних IgM, IgA, IgG, а також IL-2, -4, -10, INF-γ, TNF-2α. Статистичну обробку здійснювали в статистичному пакеті програми Exсel з використанням t-критерію Стьюдента, а також z-критерію Фішера. Методом Байєса та послідовного статистичного аналізу А. Вальда визначали діагностичну цінність окремих лабораторних показників. Результати. У ВІЛ-інфікованих осіб виявлено дисбаланс цитокінів порівняно зі здоровими особами. У серонегативних на токсоплазмоз пацієнтів були підвищені рівні IL-4 (1,57 ± 0,30 пг/мл проти 0,81 ± 0,09 пг/мл, р &lt; 0,001), IL-10 (9,81 ± 0,17 пг/мл проти 6,70 ± 0,13 пг/мл, р &lt; 0,001), ТNF-2α (2,89 ± 0,08 пг/мл проти 1,90 ± 0,04 пг/мл, р &lt; 0,001), INF-γ (9,30 ± 0,47 пг/мл проти 4,13 ± 0,12 пг/мл, р &lt; 0,001), а також загальний IgG (20,63 ± 0,65 г/л проти 16,30 ± 0,94 г/л, р &lt; 0,001). На відміну від серонегативних осіб у серопозитивних були вищими показники IL-10 (11,88 ± 0,50 пг/мл проти 9,81 ± 0,17 пг/мл, р &lt; 0,05) та INF-γ (10,75 ± 0,44 пг/мл проти 9,30 ± 0,47 пг/мл, р &lt; 0,05). Поєднання 2 ознак — INF-γ &lt; 8,8 пг/мл та IL-4 &lt; 0,77 пг/мл чи INF-γ &lt; 8,8 пг/мл та IL-10 &gt; 11,8 пг/мл або 3 ознак — IL-4 &lt; 0,77 пг/мл, IL-10 &gt; 11,8 пг/мл та IL-2 &lt; 1,5 пг/мл є предиктором розвитку токсоплазмозного енцефаліту. Висновки. Установлено, що у ВІЛ-інфікованих осіб відмічаються підвищені рівні деяких прозапальних (TNF-α, INF-γ) та протизапальних (IL-4, -10) цитокінів, але порівняно із серонегативними в серопозитивних на токсоплазмоз осіб переважають показники INF-γ і IL-10. Проявом поглибленої імунопатології та предиктором розвитку токсоплазмозного енцефаліту є зниження рівня INF-γ, IL-4, -2 із підвищенням рівня IL-10 у контингенті серопозитивних на токсоплазмоз осіб.

Manifestations of epidemic process of tuberculosis among HIV-infected patients and dependence of infection frequency on immunodeficiency level and HIV viral load

Objective. To assess the manifestations of the epidemic process of tuberculosis (TB) in HIV-infected persons and the frequency of infection depending on the level of immunodeficiency and viral load.&#x0D; Materials and methods. The epidemiological manifestations of TB incidence among HIV-infected and HIV-negative population of the Perm Region for 20142019 were studied. The frequency of TB in HIV-infected patients was determined depending on the level of immunodeficiency (96 patients) and viral load (61 patients).&#x0D; Results. On average, the incidence of TB among HIV-infected persons was by 36 times higher than that of noninfected persons. Among those infected and noninfected with HIV, TB was registered significantly more often among adults, and mainly men. The incidence of TB among HIV-infected persons is higher among urban population, while HIV-negative among rural residents. The incidence of TB in HIV-infected persons increases with an increase in the immunodeficiency and viral load.&#x0D; Conclusions. Persons with HIV infection are at risk for TB. The incidence of TB in HIV-infected persons increases with an increase in immunodeficiency and viral load.

ApoA-I mimetics reduce systemic and gut inflammation in chronic treated HIV.

Novel therapeutic strategies are needed to attenuate increased systemic and gut inflammation that contribute to morbidity and mortality in chronic HIV infection despite potent antiretroviral therapy (ART). The goal of this study is to use preclinical models of chronic treated HIV to determine whether the antioxidant and anti-inflammatory apoA-I mimetic peptides 6F and 4F attenuate systemic and gut inflammation in chronic HIV. We used two humanized murine models of HIV infection and gut explants from 10 uninfected and 10 HIV infected persons on potent ART, to determine the in vivo and ex vivo impact of apoA-I mimetics on systemic and intestinal inflammation in HIV. When compared to HIV infected humanized mice treated with ART alone, mice on oral apoA-I mimetic peptide 6F with ART had consistently reduced plasma and gut tissue cytokines (TNF-α, IL-6) and chemokines (CX3CL1) that are products of ADAM17 sheddase activity. Oral 6F attenuated gut protein levels of ADAM17 that were increased in HIV-1 infected mice on potent ART compared to uninfected mice. Adding oxidized lipoproteins and endotoxin (LPS) ex vivo to gut explants from HIV infected persons increased levels of ADAM17 in myeloid and intestinal cells, which increased TNF-α and CX3CL1. Both 4F and 6F attenuated these changes. Our preclinical data suggest that apoA-I mimetic peptides provide a novel therapeutic strategy that can target increased protein levels of ADAM17 and its sheddase activity that contribute to intestinal and systemic inflammation in treated HIV. The large repertoire of inflammatory mediators involved in ADAM17 sheddase activity places it as a pivotal orchestrator of several inflammatory pathways associated with morbidity in chronic treated HIV that make it an attractive therapeutic target.

Evolution of myocardial oedema and fibrosis in HIV infected persons after the initiation of antiretroviral therapy: a prospective cardiovascular magnetic resonance study

BackgroundHuman immunodeficiency virus (HIV) infected persons on antiretroviral therapy (ART) have been shown to have functionally and structurally altered ventricles and may be related to cardiovascular inflammation. Mounting evidence suggests that the myocardium of HIV infected individuals may be abnormal before ART is initiated and may represent subclinical HIV-associated cardiomyopathy (HIVAC). The influence of ART on subclinical HIVAC is not known.MethodsNewly diagnosed, ART naïve persons with HIV infection were enrolled along with HIV uninfected, age- and sex-matched controls. All participants underwent comprehensive cardiovascular assessment, including contrasted cardiovascular magnetic resonance (CMR) with multiparametric mapping on a 1.5T CMR system. The HIV group was started on ART (tenofovir/lamivudine/dolutegravir) and prospectively evaluated 9 months later. Cardiac tissue characterisation was compared in, and between groups using the appropriate statistical tests for the cross sectional data and the paired, prospective data respectively.ResultsSeventy-three ART naïve HIV infected individuals (32 ± 7 years, 45% female) and 22 healthy non-HIV subjects (33 ± 7 years, 50% female) were enrolled. Compared with non-HIV healthy subjects, the global native T1 (1008 ± 31 ms vs 1032 ± 44 ms, p = 0.02), global T2 (46 ± 2 vs 48 ± 3 ms, p = 0.006), and the prevalence of pericardial effusion (18% vs 67%, p < 0.001) were significantly higher in the HIV infected group at diagnosis. Global native T1 (1032 ± 44 to 1014 ± 34 ms, p < 0.001) and extracellular volume (ECV) (26 ± 4% to 25 ± 3%, p = 0.001) decreased significantly after 9 months on ART and were significantly associated with a decrease in the HIV viral load, decreased high sensitivity C-reactive protein, and improvement in the CD4 count (p < 0.001). Replacement fibrosis was significantly higher in the HIV infected group than controls (49% vs 10%, p = 0.02). The prevalence of late gadolinium enhancement did not change significantly over the 9-month study period (49% vs 55%, p = 0.4).ConclusionSubclinical HIVAC may already be present at the time of HIV diagnosis, as suggested by the combination of subclinical myocardial oedema and fibrosis found to be present before administration of ART. Markers of myocardial oedema on tissue characterization improved on ART in the short term, however, it is unclear if the underlying pathological mechanism is halted, or merely slowed by ART. Mid- to long term prospective studies are needed to evaluate subtle myocardial changes over time and to assess the significance of subclinical myocardial fibrosis.

Plasminogen Activator Inhibitor 1 (PAI-1) and Haematologic Parameters in HIV- Positive Patients on Protease Inhibitor-Based HAART Regimen: A Case-Control Study.

Background: Human immunodeficiency virus (HIV) infection is associated with an increased risk of hypercoagulability and treatment with antiretroviral agents especially protease inhibitors has also been reported to contribute to this risk. Altered fibrinolytic activity is reported as a mechanism of increased thrombotic risk in HIV patients on therapy. However, this has not been investigated in our environment. Objective: To evaluate and compare PAI-1 levels as a marker of thrombotic risk in HIV-infected persons on PI-based HAART regimen with those on non-PI-based therapy and to correlate PAI-1 with haematological parameters. Methods: This was a comparative cross-sectional study conducted at the University of Calabar Teaching Hospital (UCTH), Calabar, Cross River State. A total of 125 subjects including 45 HIV-positive patients on PI-based HAART regimen, 42 HIV-positive patients on non-PI-based HAART regimen and 38 Controls. The controls include 18 HIV-positive therapy naïve patients and 20 HIV-negative controls. PAI 1 and blood counts were estimated using standard methods. Data were analyzed using the IBM version of the statistical package for social sciences (SPSS) version 22. Statistical significance was set at 0.05. Result: The median PAI-1 level was significantly increased in patients on PI-based HAART regimen (p = 0.004). The blood counts did not differ significantly between patients on PI and non-PI-based HAART regimens (p > 0.05). There were no significant correlations between PAI-1 levels and blood counts (p > 0.05). Conclusion: PAI-1 level is elevated in HIV patients on PI-based HAART regimen. However, the association with thrombotic events could not be established in the study.

Ključne politike i mere za suzbijanje epidemije virusa humane imunodeficijencije/sindroma stečene imunodeficijencije na globalnom nivou

During the last 40 years, the development of medical HIV and AIDS related knowledge has been followed by a coordinated international HIV response, in terms of developing policies and measures for the HIV/AIDS prevention and control based on evidence from public health and clinical studies. The HIV response can be divided into three periods: the period of HIV response establishment (1981-1996); the period of multi-sectoral response (1996-2007) and the period of strengthening biomedical measures for HIV prevention (2007 and beyond). International policies and recommended HIV prevention measures have undergone a series of transformations, from the establishment of the first organized and coordinated national programs, to the design and implementation of innovative biomedical prevention measures, such as voluntary medical circumcision, pre-exposure prophylaxis and the implementation of the "test and treat" measure - the introduction of antiretroviral therapy immediately after diagnosing HIV infection to achieve undetectable viral load. New findings on successful use of antiretroviral therapy as prevention led to the formulation of goals for 2020: 90% of all people living with HIV to know their HIV status, 90% of them to receive antiretroviral therapy, and 90% of them to have viral suppression; to have less than 500 000 of both newly HIV infected persons, and AIDS related deaths. Despite of the HIV response major improvements, such as development and implementation of multisectoral national HIV/AIDS policies on prevention and control, the 2020 goals have not been meet. For achieving the main goal - ending AIDS as public health threat by 2030 - implementation of all recommended biomedical, behavioral and structural interventions should be intensified.

Factors influencing adherence to antiretroviral therapy among HIV-infected adults in Cross River State, Nigeria: a cross-sectional study.

improved access to antiretroviral therapy (ART) has significantly increased the survival and quality of life of HIV-infected persons. Strict adherence to antiretroviral therapy (ART) is crucial if viral suppression must remain optimal. We assessed predictors of adherence to ART among adult patients in Cross River State (CRS), Nigeria. a cross-sectional survey was conducted among 999 adult patients on ART in selected secondary and tertiary health facilities in CRS from January to June 2017. Respondents were recruited using multistage technique. Data were collected using a pre-tested interviewer-administered questionnaire. Adherence was defined as clients taking at least 95% of their pills in the last seven days. Multivariate analysis was performed to determine predictors of adherence at 5% level of significance. majority (70.5%) of the respondents were females with a mean age of 43.7 ± 11.1 years. The self-reported adherence rate was 60.1%. The commonest reasons for non-adherence was client travelling out of home, being busy, forgetting and lack of food. The significant predictor identified in this study was being on first-line drugs (OR=3.677, 95% C.I=2.523-5.358), were 3 times more likely to have good adherence. Predictors of poor-adherence were alcohol intake (OR=0.382, 95% C.I=0.262-0.559), dosing medications (OR=0.502, 95% C.I=0.381-0.661), CD4 cell count ≥ 500 (OR=0.723, 95% C.I=0.543-0.964), poor attitude to HIV status and medication (OR=0.713, 95% C.I=0.512-0.994) and family support (OR=0.736, 95% C.I=0.544-0.995). adherence to ART among clients in this study was fair. Majority of the reasons for poor-adherence were client-related. There is need for targeted counselling to improve adherence.