HIV-positive Individual Research Articles

Disseminating the research findings from the adolescents and adults living with Perinatal HIV (AALPHI) study: an approach from young people living with HIV

BackgroundThe Adolescents and Adults Living with Perinatal HIV (AALPHI) study is one of only three cohort studies worldwide evaluating the impact of HIV on young people living with perinatal HIV (PLHIV) relative to a comparable group of HIV negative young people in close relationship with an HIV positive individual, for example, their mother, sibling or partner. This project aimed to engage young people with the AALPHI study findings, help them take ownership, and decide how they would disseminate the key messages to both study participants and to the wider community.MethodsIn brief, 318 PLHIV and 100 HIV negative adolescents participated in AALPHI, where they each were interviewed twice, around two years apart. They were asked a wide range of psychosocial and risk behaviour questions and their cognitive function was assessed. We invited three AALPHI participants and seven members of the Youth Trials Board at the Children’s HIV Association (CHIVA) to attend up to four workshops. They were provided with the key AALPHI research findings and asked to develop them into a format that was accessible and understandable for young people. Some who had not participated before formed a group in the fourth dissemination workshop that confirmed the most important concepts and results.ResultsThe young people decided to develop a film and a leaflet about the AALPHI findings and co-produced them with a film maker and graphic designer. Challenges included working with the film maker and the venue for the first three dissemination workshops was an office space which was not ideal.ConclusionEngaging young people in the dissemination of the AALPHI findings ensured the results were communicated in a way that was more likely to be relevant, accessible and useful to those affected by the study. This project demonstrates how young people in potentially stigmatised areas of care, such as HIV, can be involved in research dissemination.

Diagnosis of Pneumocystis Jirovecii in an HIV positive individual using traditional techniques and molecular biology methods.

Pneumocystis jirovecii (PJ) è un microrganismo ubiquitario (micete) trasmesso per via aerea. <br />Persone immunocompromesse (individui HIV-positivi con conta linfocitaria CD4+ T <200 cell/micoL, disordini linfoproliferativi, trapianto di cellule staminali, malattia di Cushing) sono a rischio di sviluppare polmonite da PJ. Gli autori presentano un caso di polmonite da PJ, la cui diagnosi è stata confermata sia da lavaggio broncoalveolare (BAL) sia dal plasma del paziente con identificazione microscopica.<br />Il nostro paziente era un uomo caucasico di 35 anni, ricoverato nel reparto di malattie infettive dell’ospedale Sa Luca di Lucca, dal momento che presentava sintomi caratterizzati da febbre, dispnea, e immagine radiologica (tomografia computerizzata torace) compatibile con polmonite interstiziale bilaterale. L’uomo è stato sottoposto a BAL e prelievo di sangue periferico. I campioni sono stati analizzati con tecniche di biologia molecolare per il rilevamento e la quantificazione del DNA di PJ. Il campione BAL è anche stato analizzato per la ricerca microscopica di PJ. I campioni analizzati sono risultati positivi per PJ, sia in RT-PCR che in microscopia ottica.

Seroprevalence of Toxoplasma gondii in people at an increased risk of HIV infection – a pilot study

<br><b>Introduction:</b> The observation of the epidemiology of toxoplasmosis may prevent the development of a severe form of the disease in HIV patients.</br> <br><b>Aim:</b> The aim of the study was to evaluate the seroprevalence of <i>Toxoplasma gondii</i> in the population of the Kuyavian-Pomeranian Voivodeship at high risk of contracting HIV.</br> <br><b>Material and methods:</b> Blood serum samples of 43 patients of the Consulting and Diagnostic AIDS Center were tested for the presence of anti-HIV-1/HIV-2 antibodies and p24 antigen, and for the presence of anti-toxoplasma IgM and IgG antibodies.</br> <br><b>Results:</b> Anti-toxoplasma IgG antibody prevalence of 53.5% (23/43) was found in the study population, while the examination of specific IgM antibodies was negative. A high IgG antibody avidity index was obtained in 18 (94.7%) seropositive samples. Thirty (69.77%) of the samples were female, and 13 (30.23%) were male. Among men, HIV was detected in 1 (7.69%), and IgG antibodies against <i>T. gondii</i> in 7 (53.85%) samples. IgG antibodies against <i>T. gondii</i> were found in 16 (53.33%) women. The HIV-positive individual was 24 years old. The presence of antibodies against <i>T. gondii</i> in the IgG class was found in people of different ages (in women aged 38.44 ±13.00 years old and in men aged 29.29 ±10.86 years old). The risky situation that could cause HIV infection is in most cases sexual contacts (79.07%).</br> <br><b>Conclusions:</b> High seroprevalence of <i>T. gondii</i> was found among the studied subjects at a high risk of HIV infection. Further research is required on a larger study group.</br>

Sero-prevalance of Cryptococcal Antigenemia in HIV Positive Individual having CD4 Counts <100 Cells/mm3

Cryptococcus neoformans is one of the foremost common opportunistic infectious agents in people living with Acquired Immuno Deficiency Syndrome (AIDS). It has been reported to cause about 1 million cases of cryptococcal meningitis per year among HIV/AIDS and 600,000 deaths annually. This study was done to find the prevalence of Cryptococcal antigenemia among HIV positive individuals having CD4counts <100 cells/mm3. A cross-sectional study was conducted in the HIV Reference unit, National public health laboratory from July to December 2015. The study comprised of 99 HIV positive individuals having CD4counts <100 cells/mm3. CD4 T cell count was performed by flow cytometry (BD Biosciences, San Jose, CA, USA) and Cryptococcal antigen test by Latex agglutination assay. The overall prevalence of cryptococcal antigenemia was found to be 18.2%. Of the total ninety-nine subjects enrolled in the study, 72 (72.8%) were males and 27 (27.2%) were females. The mean age of the patients was 38 years ranging from 13 to 69 years. Higher percentage of female (22.2%) showed Cryptococcal infection in our study as compared to male (16.7%). The study concludes higher prevalence of Cryptococcal antigenemia among HIV infected individuals and recommends Cryptococcal antigen screening to be made mandatory in HIV positive patients having CD4 T cells count below 100/μl.

Use of machine learning techniques to identify HIV predictors for screening in sub-Saharan Africa

AimHIV prevention measures in sub-Saharan Africa are still short of attaining the UNAIDS 90–90-90 fast track targets set in 2014. Identifying predictors for HIV status may facilitate targeted screening interventions that improve health care. We aimed at identifying HIV predictors as well as predicting persons at high risk of the infection.MethodWe applied machine learning approaches for building models using population-based HIV Impact Assessment (PHIA) data for 41,939 male and 45,105 female respondents with 30 and 40 variables respectively from four countries in sub-Saharan countries. We trained and validated the algorithms on 80% of the data and tested on the remaining 20% where we rotated around the left-out country. An algorithm with the best mean f1 score was retained and trained on the most predictive variables. We used the model to identify people living with HIV and individuals with a higher likelihood of contracting the disease.ResultsApplication of XGBoost algorithm appeared to significantly improve identification of HIV positivity over the other five algorithms by f1 scoring mean of 90% and 92% for males and females respectively. Amongst the eight most predictor features in both sexes were: age, relationship with family head, the highest level of education, highest grade at that school level, work for payment, avoiding pregnancy, age at the first experience of sex, and wealth quintile. Model performance using these variables increased significantly compared to having all the variables included. We identified five males and 19 females individuals that would require testing to find one HIV positive individual. We also predicted that 4·14% of males and 10.81% of females are at high risk of infection.ConclusionOur findings provide a potential use of the XGBoost algorithm with socio-behavioural-driven data at substantially identifying HIV predictors and predicting individuals at high risk of infection for targeted screening.

Pyogenic granuloma-like Kaposi sarcoma: Case report and review of literature

Pyogenic granuloma-like Kaposi sarcoma (PGLKS) is an uncommon variant of Kaposi sarcoma (KS), which mimics benign pyogenic granuloma both clinically and histologically. We report a case of PGLKS of the toe occurring in a HIV-positive individual. It presented as a 2cm skin swelling of 2 weeks’ duration which was clinically felt to be a pyogenic granuloma. Histopathological examination revealed a polypoid atypical vascular lesion with overlying peripheral epidermal collarette. Spindle cell proliferation typically seen in KS was also identified, which was positive for human herpesvirus 8 (HHV8) by immunohistochemistry, confirming the diagnosis of PGLKS. Upon review of the literature, our case is the 29th case of PGLKS reported to date, and only the sixth in Asian population. Particular attention to histomorphology, and demonstration of HHV8 in lesional tissue will aid accurate diagnosis of this rare entity.

Oropharyngeal microbiome of an HIV-positive patient

Studies on understanding the human microbiome continue to grow rapidly; nonetheless, reports on alterations in the microbiome post HIV infection are limited. Human microbiome is an aggregate of bacteria, fungi, viruses and archaea that have co-evolved with humans. These microbes have important roles in immune modulation, vitamin synthesis, metabolism etc. The human pharyngeal microbiome, which resides in the junction between digestive and respiratory tracts, might have a key role in the prevention of respiratory tract infections, akin to the actions of the intestinal microbiome against enteric infections. The respiratory tract is constantly exposed to various environmental and endogenous microbes; however, unlike other similar mucosal surfaces, there has been limited investigation of the microbiome of the respiratory tract. HIV infection is associated with alterations in the respiratory microbiome. The aim of this study was to use next-generation sequencing to determine the composition of the oropharyngeal microbiome in a HIV-positive individual. The bacterial composition was determined by illumina sequencing using MiSeq of partial 16S rRNA genes (V3-V4). A total of 3, 57,926 reads were analyzed. Overall, the genera Proteus, Enterococcus, Bacteroides, Prevotella and Clostridium were most prevalent bacterial populations in the oropharynx of an HIV positive patient.

Generation of human induced pluripotent stem cells from individuals with a homozygous CCR5Δ32 mutation

Chemokine receptor 5 (CCR5) is the primary coreceptor for HIV entry into macrophages. Individuals with a homozygous deletion of 32 bp in the CCR5 gene (CCR5Δ32) are highly resistant to HIV infection (Samson et al., 1996). Allogeneic stem cell transplantation from a healthy donor with the homozygous CCR5Δ32 variant to an HIV positive individual has demonstrated efficient long-term control of HIV. We identified three individuals with this homozygous CCR5Δ32 variant, and successfully generated induced pluripotent stem cell (iPSC) lines from their dermal fibroblasts. The iPSCs lines carrying homozygous CCR5Δ32 variant displayed phenotypically normal and the potential to differentiation toward the three germ layers.

M109 - DNA METHYLATION MARKERS ASSOCIATED WITH INJECTION DRUG USE STATUS AND HIV INFECTION AMONG CHRONIC INJECTION DRUG USERS IN THE ALIVE STUDY

Background Injection Drug Use (IDU) is associated with biological modification of the genome, i.e., epigenetics marks such as DNA methylation and histone modification. However, the biological mechanisms of how substance use and cessation affects epigenetic outcomes remain largely unknown. Methods In the AIDS Linked to the Intravenous Experience (ALIVE) study, blood was obtained from 288 current IDUs, resampled after cessation and then again after relapse (total samples=774). Blood DNA methylation marks were measured using the Illumina Infinium MethylationEPIC BeadChip. Standard procedures in the minfi R package were used to preprocess raw Illumina image files into noob processed methylation beta values. Differences in DNA methylation at individual probes by current injection status were tested using generalized linear regression including age, gender, race and cell heterogeneity as covariates. DNA methylation age was estimated for study subjects using the epigenetic clock method developed by Horvath et al. Results DNA methylation at individual loci (cg10801015, p=2.47⁎10^(-11); cg11415166, p=5.15⁎10^(-10); cg03426703, p=2.62⁎10^(-9); cg14977491, p=9.94⁎10^(-8) is significantly associated with current injection drug use status after correction for multiple testing. Those CpG sites were near the PDP1, NARFL, DVL2 and PFN2 genes correspondingly. Single-site epigenetic analysis of HIV status was also performed. HIV positive individual's average biological age is about 3 years older than their chronological age, but the biological age among HIV negative individuals, injection drug users and non-users is no different from their chronological age. Discussion In a preliminary study, we performed a genome-wide scan of methylation changes in a longitudinal study of injection drug use and identified genomic locations exhibiting significant changes in peripheral DNA methylation associated with injection drug use status. Individuals with HIV infection's biological age is older than their chronological age, which is consistent with the literature.

Early experience of implementing a national HIV pre-exposure prophylaxis service in Wales, United Kingdom 2017.

Data were collected through the pre-existing Sexual Health in Wales Surveillance System, to which codes were added to capture PrEP eligibility, outcome of offer of PrEP, reasons for declining and adherence. Eligibility categories were defined based on nationally agreed criteria: men who have sex with men (MSM) and transgender people at high risk of HIV acquisition; partners of HIV-positive individuals not known to be virally suppressed; and heterosexuals reporting condomless intercourse with a HIV-positive individual not known to be virally suppressed. During the first 6 months, 516 people were eligible, 96% of which were MSM. Overall, 57% of those eligible (296/516) started PrEP. Reasons for declining PrEP were given by 88 (56%) of 157 people; 50 (57%) of whom did not believe themselves to be at risk. Of the available adherence assessments, 89% considered that all risk episodes had been covered. Persistence at 3 months was assessed for 141 people, of which 93 (66%) were still using PrEP. There were no HIV diagnoses in people taking PrEP during the first 6 months. Twenty-nine people were diagnosed with 37 episodes of sexually transmissible infections (STIs) while on PrEP. STI incidence was 105.7 per 100 person-years. The early trend indicates that implementation of PrEP is progressing as planned, and the service has been utilised by clients. This analysis can help refine implementation, inform planning and research around uptake, use and effect in Wales and internationally.

Sexual Networks of Racially Diverse Young MSM Differ in Racial Homophily But Not Concurrency.

Substantial racial disparities exist in HIV infection among young men who have sex with men (YMSM). However, evidence suggests black YMSM do not engage in greater levels of risk behavior. Sexual networks may help explain this paradox. This study used egocentric exponential random graph models to examine variation in concurrency (ie, 2 or more simultaneous partners) and homophily (ie, same race/ethnicity partners) across race/ethnicity groups in a diverse sample of YMSM. Data for this study come from a longitudinal cohort study of YMSM. Participants (n = 1012) provided data regarding their sexual contacts during the 6 months before their first study visit. A series of egocentric exponential random graph models examined how providing separate estimates for homophily and concurrency parameters across race/ethnicity improved the fit of these models. Networks were simulated using these parameters to examine how local network characteristics impact risk at the whole network level. Results indicated that homophily, but not concurrency, varied across race/ethnicity. Black participants witnessed significantly higher race/ethnicity homophily compared with white and Latino peers. Extrapolating from these models, black individuals were more likely to be in a connected component with an HIV-positive individual and closer to HIV-positive individuals. However, white individuals were more likely to be in large connected components. These findings suggest that high racial homophily combined with existing disparities in HIV help perpetuate the spread of HIV among black YMSM. Nonetheless, additional work is required to understand these disparities given that homophily alone cannot sustain them indefinitely.

Hemoptysis in an AIDS Patient

SESSION TITLE: Lung Pathology 3 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Inflammatory myofibroblastic tumor (IMT) is a rare tumor predominantly found in children. IMTs can involve any organ but the lung is most frequently involved. Here, we report a case of IMT in an HIV-positive adult with hemoptysis CASE PRESENTATION: 46 year old black male with HIV was admitted with hemoptysis. He endorsed dyspnea and weight loss and was not adherent to HAART. Absolute CD4 count on admission was 15 cells/mm3 and interferon gamma release assay was negative. CXR showed a focal opacity in the right upper lobe (RUL) and CT scan demonstrated a wedge-shaped opacity in the RUL. Sputum was negative for acid-fast bacilli. Bronchoscopy demonstrated purulent secretions from the RUL and BAL yielded blood-tinged fluid with predominance of neutrophils and macrophages. Transbronchial biopsies (TBBx) demonstrated an inflammatory infiltrate of dendritic cells, multinucleated giant cells, plasma cells, and eosinophils in a background of bland spindle cells consistent with IMT. Immunohistochemical staining was positive for muscle-specific actin and negative for anaplastic lymphoma kinase (ALK-1). Acid fast staining was negative. There was focal positivity for Epstein-Barr virus (EBV) and Human Herpesvirus 8 (HHV-8). Biopsy and BAL cultures ultimately were positive for M. avium complex (MAC). He was a poor candidate for surgical resection and was discharged home on standard three-drug therapy for MAC and HAART. DISCUSSION: IMTs represent less than 1% of all lung tumors. Pathogenesis and neoplastic potential remains uncertain. Association with infections such as MAC, EBV, and HHV-8 has been reported. Complete resection is the treatment of choice for diagnostic and therapeutic purposes. Resolution has been reported with treatment of underlying infection in non-surgical candidates. Steroids and tyrosine kinase inhibition have also been used for ALK-1 positive tumors with some success. CONCLUSIONS: IMT is an uncommon clinical entity that may mimic conditions such as malignancy or an infectious processes. Here we have described a biopsy-proven IMT via TBBx in a patient with HIV and MAC infection. We identified only one other case in the literature of pulmonary IMT in an HIV-positive individual. Reference #1: S. Cambrea, G. Resul, M. Cambrea, F. Vasilescu, A. Benedetto. Pulmonary inflammatory myofibroblastic tumor in an AIDS patient. Rom J Morphol Embryol Rep, 55 (2) (2014), p 407-412. Reference #2: J. Yu, W. Li, D. Li, Z. Zhang, T. Yu. Pulmonary inflammatory myofibroblastic tumor mimics lung cancer. Thoracic Cancer, (5) (2014), p 271-274. DISCLOSURE: The following authors have nothing to disclose: Jeet Lund, Joe Pressler, Clifford Coile, Jose Lucar Lloveras, Shradha Ahuja No Product/Research Disclosure Information

Missed Opportunities for HIV Diagnosis.

It has been previously shown that patients may present for multiple health issues in the years preceding their initial HIV diagnosis. This retrospective cohort study analyzed the data of patients with a new HIV diagnosis, at Ochsner Health System between January 1, 2011, and December 31, 2012. The primary end point was missed opportunities, the number of healthcare visits these patients made in the 2 years prior to being diagnosed with HIV. The 125 patients in the study cohort had 649 healthcare visits during which an HIV test was not performed. These missed opportunities are the key to capturing the undiagnosed and unaware HIV-positive individual. Primary care is an ideal setting to conduct HIV testing for those who have access to regular health care. However, nontraditional providers should also be encouraged to conduct HIV testing regardless of their ability to provide treatment because evidence shows that knowledge of the diagnosis may change behavior.

Cost and quality of life analysis of HIV self-testing and facility-based HIV testing and counselling in Blantyre, Malawi.

BackgroundHIV self-testing (HIVST) has been found to be highly effective, but no cost analysis has been undertaken to guide the design of affordable and scalable implementation strategies.MethodsConsecutive HIV self-testers and facility-based testers were recruited from participants in a community cluster-randomised trial (ISRCTN02004005) investigating the impact of offering HIVST in addition to facility-based HIV testing and counselling (HTC). Primary costing studies were undertaken of the HIVST service and of health facilities providing HTC to the trial population. Costs were adjusted to 2014 US$ and INT$. Recruited participants were asked about direct non-medical and indirect costs associated with accessing either modality of HIV testing, and additionally their health-related quality of life was measured using the EuroQol EQ-5D.ResultsA total of 1,241 participants underwent either HIVST (n = 775) or facility-based HTC (n = 446). The mean societal cost per participant tested through HIVST (US$9.23; 95 % CI: US$9.14-US$9.32) was lower than through facility-based HTC (US$11.84; 95 % CI: US$10.81-12.86). Although the mean health provider cost per participant tested through HIVST (US$8.78) was comparable to facility-based HTC (range: US$7.53-US$10.57), the associated mean direct non-medical and indirect cost was lower (US$2.93; 95 % CI: US$1.90-US$3.96). The mean health provider cost per HIV positive participant identified through HIVST was higher (US$97.50) than for health facilities (range: US$25.18-US$76.14), as was the mean cost per HIV positive individual assessed for anti-retroviral treatment (ART) eligibility and the mean cost per HIV positive individual initiated onto ART. In comparison to the facility-testing group, the adjusted mean EQ-5D utility score was 0.046 (95 % CI: 0.022-0.070) higher in the HIVST group.ConclusionsHIVST reduces the economic burden on clients, but is a costlier strategy for the health provider aiming to identify HIV positive individuals for treatment. The provider cost of HIVST could be substantially lower under less restrictive distribution models, or if costs of oral fluid HIV test kits become comparable to finger-prick kits used in health facilities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0577-7) contains supplementary material, which is available to authorized users.

Impact and economic evaluations of a combination prevention programme for men who have sex with men in Mexico

Background: Despite the high-profile support for combination prevention programmes (CPPs) since 2008, there is little rigorous evidence on their impact and cost-effectiveness. In 2010, Mexico received funds from the Global Fund to implement a series of behavioural, biomedical, and structural interventions over 3 years targeted to men who have sex with men. The aims of the study were to estimate the impact of the programme across a range of outcomes and cost-effectiveness. Methods: A quasi-experiment was designed before the implementation of the CPP, in which 24 cities were randomly selected for impact evaluation and 12 pairs of cities were matched. In practice, though, implementation of the programme was staggered over 1 year. Therefore, we used two different approaches to estimate impact: a difference-in-difference estimation comparing both groups and a dose–response approach using time exposure to the programme at the city level. Findings: Results from the difference-in-difference estimation showed modest impact on condom use. However, the dose–response findings revealed a 7.5% increase in HIV testing per additional year exposed to the programme, relative to baseline coverage; an increase in awareness of HIV status among HIV-positive individuals of 6.6%; a 6.4% increase in HIV-positive individuals on treatment; and an 8% reduction in the perception of stigma/discrimination from healthcare personnel. The cost per person not exposed to an untreated HIV-positive individual was gauged to be US$400. Conclusions: The study provides evidence of the effectiveness and cost of a CPP along the HIV treatment cascade: access to HIV tests, awareness of HIV status, and antiretroviral therapy initiation.

Isolation of an HIV-1 neutralizing peptide mimicking the CXCR4 and CCR5 surface from the heavy-chain complementary determining region 3 repertoire of a viremic controller.

The recent identification of neutralizing antibodies able to prevent viral rebound reemphasized the interest in humoral immune responses to control HIV-1 infection. In this study, we characterized HIV-1-inhibiting sequences from heavy-chain complementary determining region 3 (HCDR3) repertoires of a viremic controller. IgM and IgG-derived HCDR3 repertoires of a viremic controller presenting plasma-neutralizing activity and characterized by over 20 years of infection with a stable CD4 T-cell count were displayed on filamentous phage to identify HCDR3 repertoire-derived peptides inhibiting HIV-1 entry. Screening of phage libraries against recombinant gp120 led to the identification of an HCDR3-derived peptide sequence (LRTV-1) displaying antiviral properties against both X4 and R5 viruses. The interaction of LRTV-1 with gp120 was enhanced upon CD4 binding and sequence comparison revealed homology between LRTV-1 and the second extracellular loop of C-X-C chemokine receptor type 4 (CXCR4) (11/23) and the N-terminus of C-C chemokine receptor type 5 (CCR5) (7/23). Alanine scanning experiments identified different clusters of residues critical for interaction with the viral envelope protein. LRTV-1 peptide is to date the smallest human HCDR3 repertoire-derived peptide identified by phage display inhibiting HIV entry of R5 and X4 viruses. This peptide recognizes a CD4-dependent gp120 epitope critical for coreceptor binding and mimics the surface of CXCR4 and CCR5. Our data emphasize the potential of human HCDR3 immune repertoires as sources of small biologically active peptides for HIV cure.

Prevalence of opportunistic intestinal parasite infection in HIV positive population of central India region

Intestinal parasitic infections are major cause of public health problems and mortality and morbidity in tropical countries. However, everyone is suscepti-ble to parasitic infections but HIV/AIDS patients having lower immune status are at greater risk. The aim of this study was to determine the prevalence of intestinal parasitic infections in patients living with HIV/AIDS. A total of 244 consecutively sampled HIV/AIDS patients from Peoples College of Medical Sciences and Research Centre, Bhopal were included in the study. Prior con-sent of every subject was taken before collecting the stool and blood sample of every volunteer for microscopic examination and CD4 cells count. The prevalence of intestinal parasitic infection was 31.5% among HIV/AIDS pa-tients. Maximum Isospora belli infection (n=27; 35%) were observed. Para-sitic density was higher among the patients having lower CD4 T cells counts (<200/μL). Also, the prevalence of intestinal parasitic infection was decreas-ing with improvement in CD4 cell count. Considering the outcome of present study, stool examination of every HIV positive individual should also be man-datorily done to identify intestinal parasitic infections, if present and treated accordingly.

French 2013 guidelines for antiretroviral therapy of HIV-1 infection in adults.

IntroductionThese guidelines are part of the French Experts’ recommendations for the management of people living with HIV/AIDS, which were made public and submitted to the French health authorities in September 2013. The objective was to provide updated recommendations for antiretroviral treatment (ART) of HIV-positive adults. Guidelines included the following topics: when to start, what to start, specific situations for the choice of the first session of antiretroviral therapy, optimization of antiretroviral therapy after virologic suppression, and management of virologic failure.MethodsTen members of the French HIV 2013 expert group were responsible for guidelines on ART. They systematically reviewed the most recent literature. The chairman of the subgroup was responsible for drafting the guidelines, which were subsequently discussed within, and finalized by the whole expert group to obtain a consensus. Recommendations were graded for strength and level of evidence using predefined criteria. Economic considerations were part of the decision-making process for selecting preferred first-line options. Potential conflicts of interest were actively managed throughout the whole process.ResultsART should be initiated in any HIV-positive person, whatever his/her CD4 T-cell count, even when >500/mm3. The level of evidence of the individual benefit of ART in terms of mortality or progression to AIDS increases with decreasing CD4 cell count. Preferred initial regimens include two nucleoside reverse transcriptase inhibitors (tenofovir/emtricitabine or abacavir/lamivudine) plus a non-nucleoside reverse transcriptase inhibitor (efavirenz or rilpivirine), or a ritonavir-boosted protease inhibitor (atazanavir or darunavir). Raltegravir, lopinavir/r, and nevirapine are recommended as alternative third agents, with specific indications and restrictions. Specific situations such as HIV infection in women, primary HIV infection, severe immune suppression with or without identified opportunistic infection, and person who injects drugs are addressed. Options for optimization of ART once virologic suppression is achieved are discussed. Evaluation and management of virologic failure are described, the aim of any intervention in such situation being to reduce plasma viral load to <50 copies/ml.ConclusionThese guidelines recommend that any HIV-positive individual should be treated with ART. This recommendation was issued both for the patient’s own sake and for promoting treatment as prevention.

Bio-monitoring of mycotoxin exposure in Cameroon using a urinary multi-biomarker approach

Bio-monitoring of human exposure to mycotoxin has mostly been limited to a few individually measured mycotoxin biomarkers. This study aimed to determine the frequency and level of exposure to multiple mycotoxins in human urine from Cameroonian adults. 175 Urine samples (83% from HIV-positive individuals) and food frequency questionnaire responses were collected from consenting Cameroonians, and analyzed for 15 mycotoxins and relevant metabolites using LC–ESI–MS/MS. In total, eleven analytes were detected individually or in combinations in 110/175 (63%) samples including the biomarkers aflatoxin M1, fumonisin B1, ochratoxin A and total deoxynivalenol. Additionally, important mycotoxins and metabolites thereof, such as fumonisin B2, nivalenol and zearalenone, were determined, some for the first time in urine following dietary exposures. Multi-mycotoxin contamination was common with one HIV-positive individual exposed to five mycotoxins, a severe case of co-exposure that has never been reported in adults before. For the first time in Africa or elsewhere, this study quantified eleven mycotoxin biomarkers and bio-measures in urine from adults. For several mycotoxins estimates indicate that the tolerable daily intake is being exceeded in this study population. Given that many mycotoxins adversely affect the immune system, future studies will examine whether combinations of mycotoxins negatively impact Cameroonian population particularly immune-suppressed individuals.

Epstein–Barr virus expression in plasma cell neoplasms and its association with plasmablastic morphologic features

Plasma cell neoplasms include plasma cell myeloma, plasmacytoma, primary amyloidosis, and light and heavy chain deposition diseases. Epstein–Barr virus (EBV) expression has rarely been reported to be associated with plasma cell neoplasms except for patients with a previous history of transplantation or severe immunodeficiency. In contrast, EBV expression has been reported in the majority of plasmablastic lymphoma, a subtype of diffuse large B cell lymphoma. We report three cases with a plasma cell neoplasm (two plasma cell myelomas and one case of plasmacytoma), where EBV infection was diffusely detected by in situ hybridization. All three patients were under the age of 40 years, and one of the three patients was an HIV-positive individual while the other two patients did not have any identifiable source for immunosuppression. All three cases showed multifocal plasmablastic features, which is concordant with the most recent reports about the possible association of EBV expression with plasmablastic morphologic features and increased proliferative activity.