HIV-positive Man Research Articles

Exploring Epidermodysplasia Verruciformis: A Case Report, Treatment Strategies, and Emerging Therapies

Abstract Introduction/Objective Epidermodysplasia verruciformis (EV) is a rare cutaneous disorder with both inherited and acquired forms. Inherited cases involve mutations in genes such as ERV1 and ERV2, crucial for HPV immunity, while acquired cases affect immunocompromised individuals. EV is linked to cutaneous squamous cell carcinoma (SCC), highlighting the need for prompt diagnosis and treatment. Methods/Case Report A 54-year-old HIV-positive man was referred with a persistent, itchy eruption on his forearms despite given ARV regimen, oral retinoids and topical therapies. Physical examination revealed hypopigmentation and hyperkeratotic plaques on both forearms. Histologic examination revealed large cells with blue-gray cytoplasm and perinuclear halo in the upper epidermis, consistent with EV. Although advised for papilloma virus vaccination and planned for a trial of topical cidofovir, the patient was lost to follow-up. Treatment strategies for EV vary depending on lesion severity. Severe keratinized or precancerous lesions typically require surgical removal as the first-line approach. For early-stage EV with few small lesions, 5-FU, cidofovir, glycolic acid, and imiquimod is recommended. Tazarotene 0.5% cream used twice weekly has shown success in resolving lesions within 14 days. Topical imiquimod’s efficacy appears variable. In HIV-positive patients with EV, topical 1% cidofovir showed success in some cases. Systemic and topical retinoids are advised for diffuse lesions, with electrocautery or cryotherapy as options if initial treatments fail. HPV vaccination combined with oral acitretin, topical tretinoin and imiquimod led to lesion flattening. Continuous low-dose isotretinoin achieved prolonged remission of EV, but its efficacy in acquired EV remains unclear. Topical methyl aminolevulinate followed by photodynamic therapy has also shown promise. Results (if a Case Study enter NA) NA Conclusion Since its discovery in the 1970s, Acquired EV has been observed across diverse demographics, including HIV patients and organ transplant recipients. Advanced HPV typing and sequencing techniques aid in predicting SCC risk. Emerging treatments like topical cidofovir and combination therapies show promise, necessitating larger clinical trials for validation.

Hemophagocytic Lymphohistiocytosis as an Unusual Presentation in a Patient with Human Immunodeficiency Virus-associated Bone Marrow Classic Hodgkin Lymphoma: A Case Report with Literature Review

Abstract Introduction/Objective Compared to the general population, people living with human immunodeficiency virus (HIV) have a higher incidence of lymphoproliferative disorders including classic Hodgkin lymphoma (CHL). Hemophagocytic lymphohistiocytosis (HLH) triggers in HIV patients include HIV itself and HIV-associated malignancies or infections, all of which can have many overlapping symptoms, causing diagnostic challenges and delays in initiating treatments. Methods/Case Report A 56-year-old HIV-positive man presented with septic shock-like symptoms, pancytopenia, hyperferritinemia, transaminitis, elevated IL2-receptor alpha and hepatomegaly. Mild retroperitoneal lymphadenopathy found on imaging yielded non-diagnostic biopsies. A bone marrow (BM) biopsy showed no malignancy or disseminated infections and a rare hemophagocyte. Treatment for HIV-triggered HLH lead to a marked clinical improvement. Three months later he presented with worsening symptoms, negative cultures, and an EBV+ CHL on a BM biopsy. Mild increase in lymphadenopathy and multiple liver/spleen hypodensities found on imaging could not be biopsied due to rapidly deteriorating patient’s condition and death. Results (if a Case Study enter NA) NA Conclusion Per studies, HLH is more frequent in the HIV-associated lymphomas compared to the non-HIV- associated ones, usually presenting as a sepsis-like syndrome in these patients. Probability of HLH development was particularly high with BM involvement and CHL. From 2010, seven cases of HIV-associated CHL presenting with HLH were found in the literature with these findings: (n=8, including ours) sex- all males; average age- 45 years (range 28- 64); average HIV viral loads- 83,369 copies/mL (range: undetectable->300,000); average absolute CD4 count- 98 cells/microliter (range: 8-314); interval from HIV diagnosis- new to 26 years; anti-retroviral treatment- 6; symptoms- fever (all), other symptoms were variable; HLH-2004 protocol criteria- all; biopsy-proven hemophagocytes- 3; EBV+ CHL- all (6 were diagnosed on BM biopsies); outcomes- remission (2), response to treatment (4), death (2). CHL- triggered HLH in HIV patients is a complex diagnostic entity. A high index of suspicion and thorough investigations including early BM biopsies can ensure better outcomes.

Genotypic cluster analysis of Neisseria gonorrhoeae reveals a spectrum of sexual mixing including among HIV-serodiscordant men who have sex with men

Background Men who have sex with men (MSM) are more vulnerable to acquiring sexually transmitted infections (STIs). In 2019, for instance, 74% of European Neisseria gonorrhoeae (Ng) cases among males affected MSM. A recent report by the World Health Organization showed that most of the 2020’ interim targets to end STIs by 2030 had not been met. A broadened understanding of STI transmission networks could guide future elimination strategies and reduce the STI burden. Therefore, we used whole-genome sequencing (WGS) to determine Ng-clusters and assess sexual mixing. Methods WGS was performed on Ng-isolates collected at the Medical University of Vienna, Austria and was used for core genome multi-locus sequencing typing cluster analysis. Epidemiologic and infection-specific details were extracted from medical records. Results Genomic analysis and demographic data were available for 415 isolates, and 43.9% (182/415) were allocated to 31 Ng-clusters. Nine clusters comprised samples from heterosexual individuals only (women N = 4, human immunodeficiency virus (HIV)-negative men N = 49, HIV-positive man N = 1), nine clusters included MSM only (HIV-negative N = 22, HIV-positive N = 13) and 13 clusters included both heterosexuals and MSM (HIV-negative N = 75, HIV-positive N = 18). Current use of HIV pre-exposure prophylaxis (PrEP) was reported by 22.8% of MSM. In multivariate analysis, only ‘MSM’ predicted clustering with isolates from HIV-positive individuals (adjusted odds ratio 10.24 (95% CI 5.02–20.90)). Conclusions Sexual mixing of HIV-positive, HIV-negative MSM and non-MSM was frequently observed. Furthermore, HIV-serodiscordant clustering highlights the importance of PrEP rollout to avert HIV transmission. Our findings can inform future STI prevention strategies and continuous surveillance efforts are required to keep up with transmission dynamics.

Mpox Case Presenting With Genital Lesions and Proctitis.

Monkeypox (Mpox) is a zoonotic Orthopoxvirus of the Poxviridae family, endemic to Africa. In August 2022, the US government declared it an emergency because of the worldwide spread. Traditionally, Mpox infection spreads through contact with infected animals. However, the 2022 outbreak Centers for Disease Control and Prevention (CDC) data note that 94% of cases had recent male-to-male sexual or close intimate contact, suggesting a novel sexual transmission. In this article, we report a 39-year-old HIV-positive man presenting with a diffuse cutaneous rash, perianal pain, and bloody stool of 2-week duration. A medical history includes intravenous drug use and multiple sexual partners. Physical examination revealed umbilicated, tan-colored, crusted cutaneous papules scattered across the face, trunk, and genital regions. Perianal lesion biopsy showed an acanthotic epidermis with spongiosis, ballooning degeneration of keratinocytes, and the formation of multinucleated syncytial keratinocytes. A dermal superficial/lichenoid mixed inflammatory cell infiltrate with multinucleated giant cells was noted. Perianal lesion polymerase chain reaction (PCR) was positive for Mpox. Colonoscopy revealed a 3-cm circumferential rectal ulcer with gray exudate and necrosis. A rectal ulcer biopsy showed an ulcerated mucosa with acute proctitis and necrosis. There were scattered macrophages with intranuclear inclusion and glassy vacuolization, and Mpox infection was confirmed by immunostaining with a Mpox-specific anti-Vaccinia virus antibody.

Crossing the Borders – Monkey Pox in an HIV-Positive Pakistani Man Travelling from the Kingdom of Saudi Arabia; A Case Report

Monkeypox, now called Mpox, was previously endemic to central and western Africa; however, a recent outbreak of Mpox was noticed outside its traditional endemic regions. We report a case of Mpox in a 33-year-old HIV-positive gentleman, the fourth case in Pakistan and the first in Khyber Pakhtunkhwa (KP). Risk factors like age, gender, and unsafe and risky sexual behavior put this patient at risk of Mpox.

Clinicopathological and molecular approaches to the diagnosis of oral lesions in Mpox: Case report.

Mpox virus infection (MPXV) has recently been recognized as a public health emergency by the World Health Organization. While several studies have described the clinical characteristics of MPXV-oral lesions, there remains a dearth of information regarding the histological and ultrastructural oral findings. A 24-year-old HIV-positive man presented with a shallow ulcer, covered by a fibrinoid membrane, and surrounded by an erythematous halo in the hard and soft palate. The clinical appearance of the lesion raised suspicion of a viral infection; thus, the diagnosis was based on histological and electronic microscopy findings and confirmed by RT-PCR testing in the skin specimen. This case report aims to offer comprehensive insights into the clinical, histopathological, and ultrastructural features of oral lesions caused by MPXV in an individual with HIV. This report provides valuable information about the characteristics of MPXV infection in the oral mucosa, particularly in people living with HIV.

Delayed positivity of serological reactions in secondary syphilis against the background of severe HIV-induced immunosuppression

In recent decades, there has been an increase in syphilis associated with HIV infection cases, especially among men who have sex with men. The global prevalence of syphilitic infection among people living with HIV exceeds population rates. Concomitant HIV infection can affect not just the clinical course of syphilis, but also the production of antibodies to Treponema pallidum. In the presence of severe immunodeficiency in patients with HIV infection associated with secondary syphilis, the results of non-treponemal and/or treponemal tests may be false-negative or may become positive at a later date. Such cases are known, they occur infrequently and cause some diagnostic difficulties. The article presents a clinical observation of delayed positivity of serological reactions in secondary syphilis in a 23-year-old HIV-positive man from the authors' practice. The tactic of managing HIV-infected patients with clinical symptoms of syphilis and negative results of serological tests is discussed.

Nodular Syphilis Seen in an HIV-Positive Man: A Case Study.

Syphilis is becoming an increasingly concerning sexually transmitted infection in the primary care setting with a precipitous rise in cases in the USA over the past decade according to the CDC surveillance data. This rise in cases is particularly relevant in military medicine as the greatest increase in cases is among adults in their 20s. Nodular syphilis is a rare presentation of the secondary stage of syphilis, and contrary to the well-known maculopapular rash seen with syphilis infection, little is known about effective treatment of nodular manifestations of the disease. We present a case of a 54-year-old HIV-positive man with nodular secondary syphilis effectively treated with an empiric 2-week course of oral doxycycline. Initial differential diagnosis included erythema nodosum, arthropod vector disease, skin infection, and erythema elevatum diutinum. Biopsy demonstrated granulomatous dermatitis, and serology revealed positive Treponema pallidum antibodies with a rapid plasma reagin of 1:256, confirming the diagnosis of secondary syphilis with granulomatous dermatitis. This case indicates that clinicians should consider this unusual cutaneous presentation of secondary syphilis when evaluating patients with nodular skin lesions, especially in high-risk individuals.

Preventing HIV and achieving pregnancy among HIV sero-different couples: Pilot study of a safer conception intervention in Zimbabwe.

Safer conception services are needed to minimize HIV transmission among HIV sero-different couples desiring pregnancy. Few studies have evaluated the choices couples make when offered multiple safer conception methods or real-world method acceptability and effectiveness. We piloted a comprehensive safer conception program (Clintrials.gov identifier: NCT03049176) for HIV sero-different couples planning pregnancy in Zimbabwe to measure feasibility, method uptake, acceptability, pregnancy outcome, and HIV transmission. This study was not designed to compare rates of HIV transmission by safer conception method choice but rather to understand choices couples make when seeking to minimize risk of HIV transmission and maximize likelihood of pregnancy. Couples in this prospective, non-randomized study were given a choice of one or more currently available safer conception methods: antiretroviral therapy (ART) with monthly viral load (VL) monitoring for the HIV-positive partner (ART/VL), pre-exposure prophylaxis (PrEP) for the HIV-negative partner, vaginal insemination (VI) for couples with an HIV-positive woman, and semen washing (SW) for couples with an HIV-positive man. Couples were followed monthly for up to 12 months of pregnancy attempts, quarterly during pregnancy, and 12 weeks post-partum. At each visit, data on method use, urine for pregnancy testing, and blood for HIV antibody testing, or viral load if HIV-positive, were obtained. Infants born to HIV-positive women were tested for HIV at 6 and 12 weeks. Between March 2017 and June 2019, 46 individuals from 23 HIV sero-different partnerships were enrolled and followed. At enrollment, all couples chose ART/VL, and all couples chose at least one additional method; 74% chose PrEP, 36% chose SW, and 25% chose VI. During pre-pregnancy follow-up visits, three couples discontinued SW, and one couple discontinued VI; all four of these couples opted for ART/VL plus PrEP. Satisfaction with safer conception methods was high among those who chose ART/VL and PrEP. Twelve couples achieved pregnancy. There were no cases of HIV transmission to partners, and no infants tested positive for HIV. This safer conception program is feasible and acceptable, allowing sero-different couples to safely achieve pregnancy. Sero-different couples in Zimbabwe seek a combination of HIV prevention methods, particularly ART/VL plus PrEP. Trial Registration: Clintrials.gov, NCT03049176.

Multimodal Treatment of Epidermodysplasia Verruciformis in an HIV-Positive Man

Multimodal Treatment of Epidermodysplasia Verruciformis in an HIV-Positive Man

Discrepancy of PCR and serologic test on genital herpes: a case report

Background: Laboratory investigation for genital herpes (GH) includes serologic tests and polymerase chain reaction (PCR) with different sensitivity and specificity; occasionally, the results are not conclusive. Clinical symptoms are often atypical. We report a case of GH in HIV-infected patients with a non-reactive serologic test but positive PCR.
 Case Description: A 29-years old HIV-positive man presented with multiple painful shallow ulcers with pus on his penis in the last five days. PCR examination showed a positive result, whereas anti-HSV 1 IgM, anti-HSV 2 IgM, anti-HSV 2 IgG, VDRL, and TPHA were negative. The anti-HSV- 1 IgG result was reactive with a CD4 value of 122 cells/μL. The patient was given Acyclovir 3x400 mg for ten days and Co-amoxiclav 3x625 mg for seven days. Significant improvement was obtained, and the pain subsided.
 Conclusion: Clinical features of GH in infected HIV patients are often atypical and resemble other genital ulcers, thus requiring additional investigations. The serologic test may sometimes present a false negative, whereas PCR is much more sensitive and specific, nearing 100%. In patients with HIV infection, GH diagnosis at an early stage can shorten the course of the disease and prevent complications.

Monkeypox associated acute arthritis.

A 31-year-old HIV-positive man presented to the hospital on June 30, 2022, with a vesicular rash (figure A), perianal lesions, swollen inguinal lymph nodes, and arthralgia of the right knee. Under antiretroviral therapy, the HIV viral load was below the limit of detection, and his CD4+ T-cell count was 802 cells per μL. Given the rising number of monkeypox cases in Europe at that time and the patient's history of unprotected sexual contact with a man 1 week before symptom onset, an infection with monkeypox virus was suspected.

Daring to Be Different: The First-Person HIV-Positive Narrator in Two South African Novels

Masande Ntshanga’s novel The Reactive (2014) is the first South African novel written by a black male writer to feature the first-personvoice of an HIV-positive man, Lindanathi. Following Kgebetli Moele’s The Book of the Dead (2009), which gave the virus itself a voice, The Reactive heralds a significant shift in the portrayal of HIV in South African literature. Eben Venter’s Afrikaans novel Ek Stamel, EkSterwe (1996) which was translated into English by Luke Stubbs as My Beautiful Death (2004), and which has – significantly – received little critical review in English as an HIV narrative, tells the story of a white South African man, Konstant, in the Australian diaspora whoeventually succumbs to AIDS. Both novels complicate ideas of masculinity and can be described as ‘coming of age’ narratives or bildungsromans. Both novels sit historically on the cusp of change, before and after the widespread availability of ARVs. Given theircommonality of subject and narrative perspective, these texts seem ripe for comparison despite their authors’ different backgrounds. The shifts and continuities in the representation of HIV/AIDS found between these two novels, published 18 years apart, seem to disrupt the trajectory of the post-colonial bildungsroman as it is mediated (for the first time?) through the HIVpositive narrator. Reading these two novels together helps us to understand literary patterns, associations and dissociations, which reveal a cultural symbology of HIV/AIDS, part of a wider cultural symbology of illness in South African literature.

HUMAN PAPILLOMAVIRUS-ASSOCIATED ORAL EPITHELIAL DYSPLASIA: REPORT OF AN ADDITIONAL CASE

Human papillomavirus-associated oral epithelial dysplasia (HPV-OED), also referred to as apoptotic dysplasia or koilocytic dysplasia, has been rarely reported in Latin American countries. We contribute with an additional case of HPV-OED from Brazil in a 55-year-old HIV-positive man (CD4 level 300 cells/μL, and viral load undetectable), who presented a white plaque with irregular surface in his left labial commissure, with 3 years of duration. His medical history included gastric tuberculosis and current antiretroviral therapy. Incisional biopsy was performed, and microscopic evaluation showed acanthosis, hyperkeratosis, and severe epithelial dysplasia containing cells in varying stages of apoptosis. Basal and suprabasal keratinocytes were strongly positive for p16INK4a by immunohistochemistry and positive for high-risk HPV by DNA in situ hybridization. The Ki-67 proliferation index was approximately 90%. The final diagnosis was HPV-OED. The patient was submitted to conservative surgical removal, and no evidence of disease was observed after 10 months of follow-up.

Teaching NeuroImage: A Starry Sky in the Brain.

A 30-year-old HIV-positive man with a history of frequent river bathing presented with headache and fever. Neurologic examinations revealed meningeal irritation. On brain MRI, contrast-enhanced T1WI showed diffuse intracranial nodules with high signal intensity, creating a starry sky appearance (Figure A). Serum IgG antibodies against Schistosoma species were detected using ELISA. High-throughput sequencing confirmed schistosomiasis in the CSF. These findings and the absence of granulomatous diseases indicated a diagnosis of disseminated cerebral schistosomiasis. The patient was treated with glucocorticoids and praziquantel (60 mg/kg, twice/day for 5 days). One year later, a follow-up MRI showed significant lesion absorption (Figure B).

Coinfection of syphilis and monkeypox in HIV positive man in Prague, Czech Republic

Coinfection of syphilis and monkeypox in HIV positive man in Prague, Czech Republic

A Strange Umbilical Rash in a Newly Diagnosed HIV-Positive Man: A New Clinical Description of a Trichosporon Spp Dermatosis

Trichosporon is a basidiomycete yeast of tropical origin that is also opportunistic in the immunocompromised. It is characterized by irregular nodules attached to the hair called white piedra. Trichosporon spp has been reported as the 2 nd most common agent of disseminated, potentially fatal fungemia [1]. Nevertheless, no pure cutaneous manifestation had been reported. We report a single case of Trichosporon spp causing an umbilical papulonodular rash in a newly diagnosed HIV-positive subject.

18F-FDG PET/CT Findings in HIV-Positive Patient With Primary Pancreas Lymphoma and CMV Pancreatitis.

A 35-year-old HIV-positive man with abdominal pain was referred to 18F-FDG PET/CT for metabolic characterization of mass in pancreas. PET/CT images showed intense FDG uptake in head of the pancreas, as well as diffuse moderate uptake throughout body and tail of the pancreas. Histopathological results revealed Epstein-Barr virus (EBV) associated large B-cell lymphoma and pancreatitis caused by cytomegalovirus.

Case Report: Significant Complications of Cosmetic Iris Implantation

SIGNIFICANCE The complications of cosmetic iris implantation may result in irreversible vision loss. Patients who obtain these implants against general medical consensus may present to providers when sequelae develop. In symptomatic patients, providers must recognize the imminent risk to vision and mitigate further ocular damage. PURPOSE This is an observational clinical case report of a patient with significant, progressive, vision-threatening ocular pathology from prior cosmetic iris implantation, despite medical and surgical efforts to preserve vision. CASE REPORT A 35-year-old HIV-positive man with a history of cosmetic iris implants in India 16 months prior was referred to our center. He had a history of 4 months of steroid-refractory uveitis and secondary glaucoma, with IOP measurements of more than 50 mmHg in the outpatient setting. Slit-lamp examination revealed ciliary flush, pannus formation, corneal edema, and keratic precipitates. Optical coherence tomography suggested possible retinal nerve fiber layer loss in the left eye. He was diagnosed with uveitis and glaucoma, and after a short course of IOP-lowering medication, the implants were removed sequentially. Post-operatively, his course was complicated by IOP elevation, cataract development, and corneal decompensation. This led to bilateral Ahmed tube placement, Descemet's stripping endothelial keratoplasty of the right eye, and pending cataract surgery because of now-dense bilateral cataracts. CONCLUSIONS This case emphasizes the vision-threatening dangers of cosmetic iris implantation. It also demonstrates that sequelae may persist and develop despite implant removal and anticipatory management. Providers managing similar patients should carefully monitor for disease progression and maintain a low threshold for referral and/or decisive surgical intervention.

Anthemosoma garnhami in an HIV-Infected Man from Zimbabwe Living in South Africa.

An HIV-positive man from Zimbabwe living in South Africa sought treatment for multiple clinical signs, including fever, weight loss, anemia, and splenomegaly. We identified in his blood an African rodent piroplasm, Anthemosoma garnhami, related to Babesia species. This finding extends the known geographic and host range of A. garnhami.