HIV-negative Ones Research Articles

Comparison of GeneXpert accuracy in diagnosis of tuberculosis between patients with and without positive results of acid-fast bacilli smear and

BackgroundThere is controversy regarding the indications of conducting GeneXpert assay for patients suspected of tuberculosis (TB). Therefore, we compared the accuracy of the assay between patients with and without positive results of acid-fast bacilli (AFB) smear and HIV. MethodThe study was conducted on patients referred to …. TB laboratory from March 21, 2022 to March 20, 2023. Considering culture as the gold standard, we determined and compared the accuracy of GeneXpert assay and area under the Receiver Operating Characteristic (ROC) curve between high- and low-risk groups, i.e., HIV-positive or AFB smear-positive ones vs. HIV-negative ones with negative AFB smear. ResultThere was not a significant difference between the accuracy of the high- and low-risk groups (91.34 vs. 92.44, p = 0.664). While the sensitivity (95.23), specificity (92.29), and NPV (99.72) in the low-risk group were high, the PPV of the group (39.89) was significantly lower (P < 0.001) than that of the high-risk group (83.86). DiscussionBecause of the low PPV of the assay in HIV-negative patients with negative AFB smears, our study could not confirm the necessity of conducting the assay for the low-risk patients. However, the study indicated the necessity for patients with HIV or a positive AFB smear.

Breakthrough cases of mpox: One-dose vaccination is associated with milder clinical manifestations

BackgroundVery few studies have investigated the effectiveness of vaccination in decreasing the severity of breakthrough mpox. Our goal was to estimate the strength of the associations between recent mpox vaccination with MVA-BN and various clinical manifestations of the disease. MethodsTelephone interviews using standardized questionnaires, upon notification and 28 days later, of the 403 persons with mpox reported to Montreal Public Health in 2022. MVA-BN vaccination data were obtained from the provincial immunization registry. The main outcomes were numbers of skin lesions and body sites affected, other clinical manifestations (OCM) compatible with mpox, complications, and hospitalization. Findings155 persons with mpox (39% of 403) had received 1 dose of vaccine at least 14 days before symptom onset. One-dose vaccination, adjusting for age and HIV status, was significantly associated with fewer lesions, sites affected with lesions, and OCMs. HIV-positive persons with breakthrough mpox reported significantly more lesions, sites affected, and OCMs at initial interview, than HIV-negative ones. However, vaccination was associated with a lower risk of all outcomes to the same degree irrespective of HIV status. InterpretationOne dose of MVA-BN vaccine was about 60% effective in decreasing the frequency and extent of clinical manifestations, among both HIV-positive and HIV-negative persons with breakthrough mpox. Beyond preventing infection, mpox vaccination can be promoted to reduce clinical manifestations in persons at risk for mpox, even if HIV+ . FundingThis work used data obtained as part of Montreal Public Health’s 2022 mpox outbreak response and received no external funding.

Outcomes of assisted reproductive technologies in discordant couples with HIV infection in a woman

Aim. To evaluate the effectiveness of assisted reproductive technologies (art) in discordant couples with hiv-infected women.&#x0D; Materials and methods. The prospective clinical study included 432 women who received an in vitro fertilization (ivf) program. The main group included 214 subjects with hiv infection, and the control group included 218 subjects without hiv infection. In the main group, 182 "fresh" ivf/icsi (intracytoplasmic sperm injection) cycles and 162 cryocycles were performed; in the control group, 271 and 195 cycles, respectively.&#x0D; Results. The median length of HIV infection was 9.8 (5.7; 12.4) years, subclinical stage 3 of the disease prevailed (59.8%), and the duration of antiretroviral therapy was 4.5 (2.4; 8) years. The CD4+lymphocyte count [630 (496; 791) cells/μL] indicated a relatively "good" state of the immune system due to the antiretroviral therapy. In the main group, a significantly lower number of oocyte-cumulus complexes [6.5 (3; 12) and 9 (6; 15); p0.001], zygotes [4 (2; 8) and 6 (4; 10); p0.001] and blastocysts [2 (0; 2) and 4 (1; 6); p0.001] were obtained in comparison with the control group. The number of abnormally fertilized oocytes (3 or more PNs) was significantly higher in the group of HIV-infected women compared to HIV-negative ones — 0.21 (0.7) and 0.09 (0.2) (p=0.018), respectively. Evaluation of the effectiveness of "fresh" IVF/ICSI cycles showed that HIV-infected women had a significantly lower incidence of clinical pregnancy (16.5 and 32.8%; p=0.001), as well as live births (12.2 and 31.5%; p0.001). Analysis of cryocycle outcomes showed that using their own oocytes in women with HIV infection, the frequency of clinical pregnancy (27.6 and 41%; p=0.014) and childbirth (16.7 and 27.7%; p=0.021) is significantly lower than in patients without HIV infection, and in cases of using donor oocytes, these indicators are comparable between the groups (40%; p=0.910 and 25.7%; p=0.809, respectively).&#x0D; Conclusion. ART in HIV-infected women is associated with low pregnancy rates in both "fresh" and cryocycles using their own oocytes. The decrease in the oocytes/embryos obtained and the high proportion of abnormal fertilization in HIV-infected patients suggest the presence of oocyte factor as the main cause of the low effectiveness of ART programs in this group of patients.

Risk Factors Associated with Mortality of Breast Cancer Patients After Surgery: The Case of Zambia

Breast cancer (BC) has become a public health problem worldwide due to its high mortality rate among women in both developed and developing countries. The association between BC mortality and patient care and personal factors have been widely studied in developed countries. However, in Zambia, scarce data is available regarding BC mortality and its prognostic factors. We aimed to identify the factors affecting survival rates and to estimate a 5-year mortality of BC patients after surgery. Retrospective data were collected from medical records of patients from the Cancer Disease Hospital (CDH) in Lusaka, Zambia, that encompassed 233 women who had undergone BC surgery between 2013 and 2018, and who were followed up to the end of 2019. Prognostic factors of BC mortality after surgery using a Logistic regression model were determined. The most commonly used statistic of comparison was the odds ratio (OR). Further, 5-year mortality rates for various age groups were estimated using the fitted model. Age at surgery, marital status, HIV status, BMI, BC stage, histologic grade, PR status were significantly associated with mortality of BC patients after surgery. The odds of death increased with the degree of severity across the levels of factors such as tumour size, lymph node status, BC stage and histologic grade. Also, the odds ratio for mortality increased with an increase in the age of patients. Additionally, the odds of death were higher for HIV-positive and unmarried patients compared to the HIV-negative and married ones. Further, the odds of death for obese or overweight patients were more than twice that of those classified as not obese. Furthermore, the 5-year mortality of different age groups using multiple logistic regression stood at 75.4% for the younger group (≤ 35 years) and 99% for the older group (50 &lt;= age).

HPV genotyping in biopsies of HSIL and invasive cervical cancers in women living with HIV: A cohort- and a nested -case control study

ObjectiveTo characterize HPV genotype distribution in HSIL and ICC- biopsies, of WLWH, in Europe, as compared to HIV-negative women. DesignCohort- and nested -case control study. MethodWe characterized HPV genotype distribution by performing PCR on HSIL and ICC biopsies from WLWH (n = 170); 85 cases were compared to 85 HIV-negative matched controls. The proportion of patients that might be protected by HPV vaccines was estimated. ResultsAmong WLWH (median age 36 years-old, median duration of HIV infection 70,5 months, 79% under cART): the most frequently detected HPV were HPV16 (30%), HPV35 (16%), HPV58 (14,7%), HPV31 (13,5%), and HPV52 (11,7%). HPV16 was less frequently found in WLWH, originating from Central Africa (20,5%) compared to other African regions (35,5%) (p = 0,05) or world regions (38,8%) (p = 0,007). Multiple versus single high-risk HPV infections were associated with younger age (≤35 years)(odds ratio (OR) 2,65 (95%IC: 1,3–5,2,p = 0,002), lymphocyte CD4 count < 350 cells / µL (OR 2,7 (95%IC: 2–8,5; p = 0,005), use of cART for < 18 month OR 2,2 (95%IC: 1,1–4,5),p = 0,04) or a cumulative time with undetectable HIV viral load of less than 12 months (OR 4,2 (95%IC: 2–8.5,p = 0,001). HPV 31, 33 and 35 were more frequently detected in samples from WLWH than in HIV-negative controls (p < 0,05). The 9-valent vaccine would increase HPV protection, in HIV-positive and negative women (p < 0,001). ConclusionWLWH are more frequently infected with high-risk HPV other than 16 and 18 than HIV-negative ones. The use of 9-valent vaccine may prevent HSIL or ICC in up to 85% of the women. Adding HPV 35 to the HPV vaccine panel, might improve vaccine effectiveness in WLWH.

Should the management of high grade cervical squamous intraepithelial lesion (HSIL) be different in HIV-positive women?

BackgroundThis study compares the management and outcome of high grade squamous intraepithelial lesions (HSIL) in HIV-positive and -negative women and identifies risk factors for treatment failure.MethodsThis retrospective, controlled study includes 146 HIV-positive women, matched for HSIL, age and year of diagnosis, with 146 HIV-negative women. Differences were analysed using parametric and non-parametric tests and Kaplan–Meier survival curves. A binary logistic regression was used to assess risk factors for treatment failure.ResultsPersistence of cervical disease was observed most frequently in HIV-positive women (42 versus 17%) (p < 0.001) and the cone biopsy margins were more often invaded in HIV-positive-women than in HIV-negative ones. (37 versus 16%; p < 0.05).HIV-positive women, with successful cervical treatment had better HIV disease control: with significantly longer periods of undetectable HIV viral loads (VL) (19 versus 5 months; p < 0.001) and higher CD4 counts (491 versus 320 cells/mm3; p < 0.001). HIV-positive women with detectable VL at the time of dysplasia had 3.5 times (95% IC: 1.5–8.3) increased risk of treatment failure. Being treated through ablative therapy was associated with a 7.4, four-fold (95% IC: 3.2–17.3) increased risk of treatment failure compared to conizationConclusionHIV-positive women have a higher risk of treatment failure of HSIL than do HIV-negative women, especially when ablative therapy is used and in women with poor control of their HIV infection. The management and the follow- up of HSIL’s guidelines in this high-risk population should be adapted consequently: for HIV-positive women with uncontrolled viral load, excisional treatment should be the preferred therapy, whereas for women with undetectable viral load, CD4 + lymphocytes higher than 500 cells/mm3 and with a desire of pregnancy, ablative therapy may be considered.

Rotavirus disease burden pre-vaccine introduction in young children in Rural Southern Mozambique, an area of high HIV prevalence.

BackgroundRotavirus vaccines have been adopted in African countries since 2009, including Mozambique (2015). Disease burden data are needed to evaluate the impact of rotavirus vaccine. We report the burden of rotavirus-associated diarrhea in Mozambique from the Global Enteric Multicenter Study (GEMS) before vaccine introduction.MethodsA case-control study (GEMS), was conducted in Manhiça district, recruiting children aged 0–59 months with moderate-to-severe diarrhea (MSD) and less-severe-diarrhea (LSD) between December 2007 and November 2012; including 1–3 matched (age, sex and neighborhood) healthy community controls. Clinical and epidemiological data and stool samples (for laboratory investigation) were collected. Association of rotavirus with MSD or LSD was determined by conditional logistic regression and adjusted attributable fractions (AF) calculated, and risk factors for rotavirus diarrhea assessed.ResultsOverall 915 cases and 1,977 controls for MSD, and 431 cases and 430 controls for LSD were enrolled. Rotavirus positivity was 44% (217/495) for cases and 15% (160/1046) of controls, with AF = 34.9% (95% CI: 32.85–37.06) and adjusted Odds Ratio (aOR) of 6.4 p< 0.0001 in infants with MSD compared to 30% (46/155) in cases and 14% (22/154) in controls yielding AF = 18.7%, (95% CI: 12.02–25.39) and aOR = 2.8, p = 0.0011 in infants with LSD. The proportion of children with rotavirus was 32% (21/66) among HIV-positive children and 23% (128/566) among HIV-negative ones for MSD. Presence of animals in the compound (OR = 1.9; p = 0.0151) and giving stored water to the child (OR = 2.0, p = 0.0483) were risk factors for MSD; while animals in the compound (OR = 2.37, p = 0.007); not having routine access to water on a daily basis (OR = 1.53, p = 0.015) and washing hands before cooking (OR = 1.76, p = 0.0197) were risk factors for LSD.ConclusionThe implementation of vaccination against rotavirus may likely result in a significant reduction of rotavirus-associated diarrhea, suggesting the need for monitoring of vaccine impact.

Urinary tract infection in HIV-positive women

Introduction: Urinary tract infections (UTI) are common in women and can cause systemic repercussions. In pregnant women, for example, the occurrence of UTI or asymptomatic bacteriuria (AB) can lead to premature birth and fetal death. The generalized immune depletion caused by HIV is related to the exacerbation of infections, and may be related to UTI. Objective: The objective of this review was to evaluate the characteristics of UTI in pregnant and non-pregnant HIV-positive women as well as the factors that interfere in its occurrence. Methods: By searching the databases PubMed, Web of Science, Scielo and Lilacs, we selected eleven articles that correlated UTI and HIV infection in women. Results: Our analysis showed that HIV-positive pregnant women have a higher predisposition to UTI than HIV-negative ones. The Viral Load (VL) is directly related to UTI and AB in HIV-positive non-pregnant women. TCD4 lymphocyte levels (TCD4) lower than 200 cells/mL and VL over 10,000 copies/mL are correlated with higher UTI and AB rates in HIV-positive pregnant women. There is a tendency for greater variability of pathogens in HIV-positive women and a predisposition to higher rates of antibiotic resistance in HIV-positive pregnant women. Conclusion: HIV-positive pregnant women have higher predisposition to urinary tract infection and its incidence is correlated with a high viral load and a low TCD4 count.

Predictive ability of risk assessment tool regarding HIV infection for men who have sex with men

Objective: To analyze the predictive ability of HIV infection risk assessment tool for men who have sex with men (MSM). Sentinel surveillance data of MSM in Taizhou prefecture of Zhejiang province was used. Methods: MSM involved in AIDS sentinel surveillance program in Taizhou from 2013 to 2017 were included in the study and items listed in the HIV infection risk assessment tool for MSM was revised. Related data on questions and options involved in sentinel surveillance was collected and individual risk scores were calculated. We determined the predictive ability of this tool by comprehensive analyzing the HIV infection status and individual risk scores. Results: A total of 1 944 MSM were included in the study, with an average age of (35.04±13.28)years old. Most of them were recruited from the venues (55.7%) and 48.2% were never married. Among these MSM, HIV infection rate was 12.6%(245/1 944) with the median of risk score as 23.99, versus 20.36 from the HIV negative ones. Significant differences appeared on the risk scores between the target populations that with different HIV status (Mann-Whitney test, P=0.007). According to the principle of decision tree, MSM were divided into two groups according to risk scores: ≤18.66 and >18.66. It appeared that the risk scores were in parallel with the rates of HIV infection (χ(2)=13.102, P<0.001). Results from the multivariate analysis showed that MSM with higher risk score were more likely to be infected with HIV (>18.66 vs. ≤18.66: aOR=1.72, 95%CI: 1.27-2.32, P<0.001). Area under the ROC curve (AUC) for HIV infection was 0.553 (95%CI: 0.516-0.590, P=0.007). At the point of risk score 19.01, Youden's index appeared the maximum, with sensitivity as 0.69 and specificity as 0.43, of this tool. Conclusions: The HIV infection risk assessment tool for MSM developed based on Delphi method can predict the risk of HIV infection in MSM to some extent. MSM with higher risk score seemed likely to be infected with HIV. Items of this tool need to be adjusted for the verification of the tool through cohort studies in the near future.

MAGNETIC RESONANCE IMAGING FOR DIAGNOSTICS OF COMPRESSION MYELOPATHY IN PATIENTS WITH INFECTIOUS SPONDYLITIS

The clinical and neurological status and magnetic resonance imaging (MRI) of the spine were studied in successively examined 100 patients with suspected infectious spondylitis. The study design is a prospective monocentric cohort with a period of recruitment of the material in 2015–2017. Level of evidence — III. The prevalence of intramedullary changes in the form of gliosis/myeloischemia-edema in comparison with other variants of the detected changes was revealed; the presence of a higher degree of spinal sagittal stenosis (SCSs) and spinal cord kifosis (SCK) and also the average number of affected vertebrae in tuberculous spondylitis than in non-specific ones has been proven. In HIVpositive patients, higher values of the degree of maximum sagittal canal stenosis (SCSs) were observed than in HIVnegative ones. The statistical dependence between the severity of neurological disorders estimated by the Frankel scale with the etiology of the process and with specific variants of structural changes in the spinal cord has not been proven. Indicators of tactile and pain sensitivity were significantly higher in patients with intramedullary changes in the form of gliosis / myeloischemia-edema than in myelomalacia.

The effect of aggressive chemotherapy in a model for HIV/AIDS-cancer dynamics

Patients infected with the human immunodeficiency virus (HIV) are more vulnerable to develop various types of cancer, in particular, Hodgkin’s lymphoma, Kaposi’s sarcoma and vulvar cancer. Moreover, cancers progression tend to be more aggressive in HIV-positive individuals than in HIV-negative ones. In this work, we develop an impulsive mathematical model to describe the dynamics of cancer growth and HIV infection, when chemotherapy and treatment for HIV, namely, highly active antiretroviral therapy (HAART) are included. Chemotherapy is applied using periodic impulsive perturbations, which simulate drugs instantaneous application, when chemotherapy takes place. We use path-following (continuation) methods, for hybrid dynamical systems, to analyze the upshot of the chemotherapy on the HIV viral load and in cancer cells’ growth. The control parameters are set to be: (i) the frequency of chemotherapy applications and (ii) the amount of drug applied per injection. Our findings disclose that HIV control is impacted by the existence of a codimension-one bifurcation of limit cycles, corresponding to a branching point. Clinical inferences are drawn from these results.

ОСОБЕННОСТИ РЕЦИДИВОВ ТУБЕРКУЛЕЗА У ПАЦИЕНТОВ С ВИЧ-ИНФЕКЦИЕЙ

The growing number of people with advanced stages of HIV infection determines the specific course of newly diagnosed tuberculosis cases and relapses and accordingly, it requires a special approach to follow-up of such patients respective their dispensary group. The objective of the study : to define the specific features of tuberculosis relapses in HIV patients. Subjects and methods . 205 patients from Sverdlovsk Region were enrolled into a retrospective study. In all the patients, a relapse of respiratory tuberculosis was diagnosed (there were some single cases of combinations with other localizations of tuberculosis). Of them, 104 patients were diagnosed with HIV infection (Group I) and 101 patients were HIV negative (Group II). The groups were compatible respective the age and gender of the patients. Results . HIV positive patients develop tuberculosis relapses earlier versus the HIV negative ones (in 31.5 ± 3.0 months and 55.1 ± 5.7 months respectively, p < 0.001). When tuberculosis relapse was diagnosed, 49.0% (95% CI 47.1-77.7) of patients with HIV infection had their CD4 count < 200 cells/mcl, and most often such a low count was observed among the patients who had CD4 count of 200-349 cells/mcl at the moment when tuberculosis was cured. By the time when tuberculosis relapse was diagnosed among HIV positive patients, the level of antiretroviral therapy failure increased and made 31.7%, and there was a tendency (nearly statistically significant) towards the increase of the portion of ARVT courses lasting for less than 6 months. In case of tuberculosis relapse, HIV positive patients developed disseminated and generalized tuberculosis more often versus HIV negative ones. The most frequent defects of dispensary follow up (dispensary follow-up group III) over the patients cured of tuberculosis, were the lower frequency of X-ray and bacteriological examinations and underestimation of clinical manifestations. It results in the postponed diagnostics of relapse long after its manifestations, less frequent diagnostics of relapses during planned examination, especially in HIV patients. Probably, it is worth reconsidering the tactics of dispensary follow-up over HIV positive patients with TB history and following them up longer as active dispensary groups. The following could be the additional criteria for dispensary follow-up extension: CD4 count of 200 cells/mcl and lower and laboratory confirmed failing ARVT.

THE SERUMAL CONCENTRATION OF HBSAG IN PATIETS WITH CHB/HIV CO-INFECTION COMPARING WITH CHB MONO-INFECTION IN THE DIFFERENT PHASES OF NATURAL COURSE OF CHRONIC HEPATITIS В

The prevalence and inclination to chronization of viral hepatitis B is 3 – 5 times higher in patients with HIV-infection than in HIV-negative ones. The natural clinical course of chronic hepatitis B (CHB) in patients with HIV has the features, connected with immune suppression and mutual influence of viruses. The quantitative determination of HBsAg allows the more precise monitoring of the natural course and the dynamics of treatment of patients with CHB but these features are little studied in patients with co-infection CHB/HIV. In the work was presented the comparative analysis of the results of quantitative determination of the serumal HBsAg in 59 Patients with co-infection CHB/HIV and 60 ones with chronic hepatitis. At the study it was established, that in patients with CHB/HIV co-infection were observed the reliably higher qHBsAg levels than in HIV-negative ones both in whole and in each CHB phase that depends on the immune suppression degree and DNA level of hepatitis B virus.

Injecting Drug Use as a Factor Contributing to HIV Infection

was to establish the impact of injecting drug use on cellular immunity and to evaluate the significance of drug useas a factor contributing to HIV infection and affectingthe course of disease in HIV-positivepatients. The study included 144 subjects: 109patients (49 – with drug addiction, 23 – withHIV infection, 37 – with drug addiction and HIV infection) and35 virtually healthy individuals. Thetotal amount of T-lymphocytesdoes not depend on HIVstatus, drug addiction orgender, aswell as on the combinedeffect of these factors. The total number of lymphocytes, the percentage and the absolute countof B cells (CD19 + lymphocytes) and CD4 +25+ cells (mainly T-regulatorylymphocytes) in blood was significantly lower in HIV-positive patients comparedto HIV-negative ones; drugaddiction andgender do not havea significant effect onthese parameters. Injecting drug use potentiatesthe effects caused by HIV infection: reducedpercentage of T-helpercells (CD4+lymphocytes), number of T-NK-cells(CD3+16+56+ lymphocytes),percentage and absolutecount of NK cells (CD3-16+56+ cells), increasedpercentage of cytotoxicT lymphocytes (CD8+cells), percentageand absolute number of T-lymphocytes with signs of activation(CD3+HLA-DR+ cells). Injectingdrug use increases therisk of infection inHIV-negative IDUs andreduces the antiviralresponse in HIV-positivepatients, significantly potentiatingeffects of HIVinfection: reduced blood levelof T-helpers, T-NKand NK cells, regulatorycells, immunehyperactivation – allof this may contribute tothe disease progression.

Helicobacter pylori infection in HIV-positive patients with digestive complaints

Background. Patients infected with human immunodeficiency virus (HIV), especially at advanced stages of HIV infection and low CD4+ T-lymphocytes levels, were reported to be less frequently co-infected with Helicobacter pylori than general population, according to literature data. Purpose: to study Helicobacter pylori infection in HIV-positive hosts with digestive complaints. Methods: retrospective, analytical, case-control study (November 2011 December 2013), upon two groups of patients with gastro-intestinal symptoms tested for Helicobacter pylori stool antigen at the Infectious Diseases Laboratory, Clinical County Hospital Mures. Group A included 44 HIV-positive patients, group B: 58 HIV-negative subjects. We first compared groups A and B regarding the frequency of Helicobacter pylori infection. Group A was afterwards divided into two sub-groups, according to the status of Helicobacter pylori infection: group A1: 5 Helicobacter pylori-positive subjects, group A2: 39 Helicobacter pylori-negative ones. We collected information regarding CD4+ T-lymphocytes level, HIV-RNA plasma viral load, previous antibiotic and antiretroviral therapy, co-morbidities, comparing A1 and A2 subgroups. Data were processed using GraphPad Prism 5 programme. Results. The frequency of Helicobacter pylori infection was 11.36% among HIV-positive patients and 13.79% in HIV-negative ones, without statistically significant difference. We found no statistically significant differences between subgroups A1 and A2 regarding CD4+ T-lymphocytes level, HIV-RNA plasma viral load, antibiotic / antiretroviral therapy. Conclusions. Though Helicobacter pylori infection may represent one of the causes of gastro-intestinal symptoms in HIV-positive patients, its frequency did not differ to that registered in the general population, in our study.

Biofilm production in oral Candida isolates from HIV‐positive individuals from Pune, India

Biofilm formation is implicated as a potential virulence factor in Candida species and carries important clinical repercussions because of their increased resistance to antifungal treatment, ability to withstand host defences and to serve as a reservoir for continuing infections. The present study was undertaken to determine the biofilm production among oral Candida isolates from HIV-positive and HIV-negative individuals from Pune, India. Biofilm formation was determined using the spectrophotometric or microtitre plate method in 182 Candida isolates, of which 154 were from HIV-positive and 28 were from HIV-negative individuals. A total of 63.2% of the Candida isolates were biofilm producers. Significantly increased biofilm forming abilities both qualitatively as well as quantitatively were observed in Candida isolates from HIV-positive individuals (66.2%) compared to isolates from HIV-negative ones (46.4%), (P- 0.041). Eighty-one (59.6%) C. albicans isolates and 34 (73.9%) non -C. albicans Candida (NCAC) showed biofilm positivity. The NCAC showed significantly greater intensity of biofilm formation compared to the C. albicans, P- 0.032. Our results thus show the enhanced biofilm forming abilities of oral Candida isolates from HIV-infected individuals compared to HIV-uninfected ones and highlight the important role played by biofilm formation in the pathogenesis of NCAC isolates.

Cervical cancer screening by visual inspection in Côte d'Ivoire, operational and clinical aspects according to HIV status

BackgroundCervical cancer screening is not yet standard of care of women attending HIV care clinics in Africa and presents operational challenges that need to be addressed.MethodsA cervical cancer screening program based on visual inspection methods was conducted in clinics providing antiretroviral treatment (ART) in Abidjan, Côte d'Ivoire. An itinerant team of midwives was in charge of proposing cervical cancer screening to all HIV-positive women enrolled in ART clinics as well as to HIV-negative women who were attending the Abidjan national blood donor clinic. Positively screened women were systematically referred to a colposcopic examination. A phone-based tracking procedure was implemented to reach positively screened women who did not attend the medical consultation. The association between HIV status and cervical cancer screening outcomes was estimated using a multivariate logistic model.ResultsThe frequency of positive visual inspection was 9.0% (95% CI 8.0-10.0) in the 2,998 HIV-positive women and 3.9% (95% CI 2.7-5.1) in the 1,047 HIV-negative ones (p < 10-4). In multivariate analysis, HIV infection was associated with a higher risk of positive visual inspection [OR = 2.28 (95% CI 1.61-3.23)] as well as more extensive lesions involving the endocervical canal [OR = 2.42 (95% CI 1.15-5.08)]. The use of a phone-based tracking procedure enabled a significant reduction of women not attending medical consultation after initial positive screening from 36.5% to 19.8% (p < 10-4).ConclusionThe higher frequency of positive visual inspection among HIV-positive women supports the need to extend cervical cancer screening program to all HIV clinics in West Africa. Women loss to follow-up after being positively screened is a major concern in cervical screening programs but yet, partly amenable to a phone tracking procedure.

Effectiveness of a PMTCT programme in rural Western Kenya

We assess the coverage of a Prevention of Mother-to-child Transmission (PMTCT) programme in Busia (Kenya) from 1 January 2006 to 31 December 2008 and estimate the risk of transmission of HIV. We also estimate the odds of HIV transmission according to pharmacological intervention received. Programme coverage was estimated as the proportion of mother–baby pairs receiving any antiretroviral (ARV) regimen among all HIV-positive women attending services. We estimated the mother-to-child transmission (MTCT) rate and their 95% confidence interval (95%CI) using the direct method of calculation (intermediate estimate). A case–control study was established among all children born to HIV-positive mothers with information on outcome (HIV status of the babies) and exposure (data on pharmacological intervention). Cases were all HIV-positive children and controls were the HIV-negative ones. Exposure was defined as: (1) complete protocol: ARV prescribed according World Health Organisation recommendations; (2) partial protocol: does not meet criteria for complete protocol; and (3) no intervention: ARVs were not prescribed to both mother and child. Babies were tested using DNA Polymerase Chain Reaction at six weeks of life and six weeks after breastfeeding ceased. In the study period, 22,566 women accepted testing, 1668 were HIV positive (7.4%; 95%CI 7.05–7.73); 1036 (62%) registered in the programme and 632 were lost. Programme coverage was 40.4% (95%CI 37.9–42.7). Out of the 767 newborns, 28 (3.6%) died, 148 (19.3%) defaulted, 282 (36.7%) were administratively censored and 309 (40.2%) babies completed the follow-up as per protocol; 49 were HIV positive and MTCT risk was 15.86% (95%CI 11.6–20.1). The odds of having an HIV-positive baby was 4.6 times higher among pairs receiving a partial protocol compared to those receiving a complete protocol and 43 times higher among those receiving no intervention. Our data show a good level of enrolment but low global coverage rate. It demonstrates that ARV regimens can be implemented in low resource rural settings with marked decreases of MTCT. Increasing the coverage of PMTCT programmes remains the main challenge.

Low prevalence of H. pylori Infection in HIV-Positive Patients in the Northeast of Brazil

BackgroundThis study conducted in Northeastern Brazil, evaluated the prevalence of H. pylori infection and the presence of gastritis in HIV-infected patients.MethodsThere were included 113 HIV-positive and 141 age-matched HIV-negative patients, who underwent upper gastrointestinal endoscopy for dyspeptic symptoms. H. pylori status was evaluated by urease test and histology.ResultsThe prevalence of H. pylori infection was significantly lower (p < 0.001) in HIV-infected (37.2%) than in uninfected (75.2%) patients. There were no significant differences between H. pylori status and gender, age, HIV viral load, antiretroviral therapy and the use of antibiotics. A lower prevalence of H. pylori was observed among patients with T CD4 cell count below 200/mm3; however, it was not significant. Chronic active antral gastritis was observed in 87.6% of the HIV-infected patients and in 780.4% of the control group (p = 0.11). H. pylori infection was significantly associated with chronic active gastritis in the antrum in both groups, but it was not associated with corpus chronic active gastritis in the HIV-infected patients.ConclusionWe demonstrated that the prevalence of H. pylori was significantly lower in HIV-positive patients compared with HIV-negative ones. However, corpus gastritis was frequently observed in the HIV-positive patients, pointing to different mechanisms than H. pylori infection in the genesis of the lesion.

Plasmodium falciparum Infection Significantly Impairs Placental Cytokine Profile in HIV Infected Cameroonian Women

BackgroundPlacental cytokines play crucial roles in the establishment and maintenance of pregnancy as well as protecting the foetus from infections. Previous studies have suggested the implication of infections such as P. falciparum and HIV in the stimulation of placental cytokines. This study assessed the impact of P. falciparum on placental cytokine profiles between HIV-1 positive and negative women.Materials and Methods P. falciparum infection was checked in peripheral and placental blood of HIV-1 negative and positive women by the thick blood smear test. Cytokines proteins and messenger RNAs were quantified by ELISA and real time PCR, respectively. Non-parametric tests were used for statistical analyses.ResultsPlacental and peripheral P. falciparum infections were not significantly associated with HIV-1 infection (OR: 1.4; 95% confidence interval (95%CI): 0.5–4.2; p = 0.50 and OR: 0.6; 95%CI: 0.3–1.4; p = 0.26, respectively). Conversely, placental P. falciparum parasitemia was significantly higher in the HIV-1 positive group (p = 0.04). We observed an increase of TNF-α mRNA median levels (p = 0.02) and a trend towards a decrease of IL-10 mRNA (p = 0.07) in placenta from HIV-1 positive women compared to the HIV negative ones leading to a median TNF-α/IL-10 mRNA ratio significantly higher among HIV-1 positive than among HIV-1 negative placenta (p = 0.004; 1.5 and 0.8, respectively). Significant decrease in median secreted cytokine levels were observed in placenta from HIV-1 positive women as compared to the HIV negative however these results are somewhat indicative since it appears that differences in cytokine levels (protein or mRNA) between HIV-1 positive and negative women depend greatly on P.falciparum infection. Within the HIV-1 positive group, TNF-α was the only cytokine significantly associated with clinical parameters linked with HIV-1 MTCT such as premature rupture of membranes, CD4 T-cell number, plasma viral load and delay of NVP intake before delivery.ConclusionsThese results show that P. falciparum infection profoundly modifies the placenta cytokine environment and acts as a confounding factor, masking the impact of HIV-1 in co-infected women. This interplay between the two infections might have implications in the in utero MTCT of HIV-1 in areas where HIV-1 and P. falciparum co-circulate.