HIV-positive Patients Research Articles

The Risk Factors of High-Risk Human Papillomavirus Susceptibility and Clinical Features in HIV-Positive Patients with Anal Condyloma Acuminatum: A Retrospective Cohort Study

The Risk Factors of High-Risk Human Papillomavirus Susceptibility and Clinical Features in HIV-Positive Patients with Anal Condyloma Acuminatum: A Retrospective Cohort Study

Revisiting tuberculosis diagnosis: the prospect of urine lipoarabinomannan assay as a diagnostic tool in people living with human immunodeficiency virus

Abstract Background Tuberculosis, since its discovery has become a global health burden, continuously spreading across the nations of the earth with increased mortality. Its effect on human immunodeficiency virus (HIV) progression and immune cell deterioration cannot be overlooked. The widespread use of traditional and molecular TB diagnostic methods has been hindered by several factors. Nonetheless, the development of a rapid, sensitive, timely, non-invasive diagnostic protocol could revolutionise the diagnostic era and halt the spread of this infectious agent. It could also help in the early diagnosis of the infection in poorly developed areas. The detection efficacy of urine lipoarabinomannan assay as a prospect in tuberculosis diagnosis in HIV-positive patients was assessed in this study. Urine samples were collected into a wide-mouthed universal container from HIV-positive patients with signs and symptom of tuberculosis and HIV advanced disease. Alere determine urine lateral flow—LAM test was used for the detection of LAM antigen in urine samples of HIV-positive patients. The CD4 count of the HIV-positive patients was also documented. Results A total of 85 HIV-positive subjects were included in the analysis based on the inclusion criteria. Urinary LAM was reactive in 29 (34.1%) of 85 HIV-positive patients and non-reactive in 56 (69.1%). The majority of the participants had a CD4+ count < 200 cells/µL 60 (70.6%), while others had CD4+ count ≥ to 200 cells/µL 25 (29.4%). There was no statistically significant difference between CD4 count and LAM positivity. Most of the affected age groups in the study were 31–45 years, and females had preponderance in comparison to male subjects. Conclusions The use of urinary LAM in HIV-positive patients is a helpful tool for TB screening. It also has a promising ability for early TB diagnosis in the study group and other TB-associated disease conditions in resource-deprived settings. For the general populace, further research is required to certify its sensitivity and specificity.

IMPLANTES DENTÁRIOS INSTALADOS EM PACIENTES PORTADORES DO VIRUS DA IMUNODEFICIENCIA HUMANA (HIV)

The Human Immunodeficiency Virus (HIV) compromises the immune system and, as it progresses, causes acquired immunodeficiency syndrome (AIDS), characterized by the emergence of opportunistic infections. Transmission occurs mainly through sexual contact or via blood and, in Brazil, between 1980 and 2022, more than 1 million cases of AIDS were recorded. Regarding implantology, patients with HIV face oral complications such as gingivitis and candidiasis, and although the impact of osseointegrated implants in these patients is not yet entirely clear, prior evaluation of bone health and conditions is essential. This research aims to describe the care in the osseointegration process in HIV-positive patients, investigating the possible complications and the importance of biosafety, in addition to highlighting the relevance of treatment to improve the quality of life of these patients. The methodology used was the bibliographic review, using articles published between 2012 and 2022 in Portuguese. Oral rehabilitation with dental implants in HIV-positive patients has gained importance due to the increase in life expectancy provided by antiretroviral therapy. These patients, with an improved quality of life, are looking for viable options to replace missing teeth, with dental implants being an attractive alternative. Although the literature on the topic is limited, the results indicate that the success rates of implants in patients with HIV are similar to those of healthy patients, as long as the treatment considers the immune status. However, specific care is needed, such as monitoring for possible complications resulting from the continuous use of antiretrovirals, which can cause liver and kidney problems. Additionally, strict biosafety protocols are essential to ensure the safety of patients and healthcare providers. Further research is recommended to clarify outstanding issues and improve pre- and postoperative care, providing more predictable outcomes and greater safety in treatment with osseointegrated implants.

Paradoxical deterioration during treatment of tuberculous meningitis responded to infliximab but not to steroids

Paradoxical deterioration in patients with tuberculous meningitis is a significant diagnostic and treatment challenge. We present the case of a 55-year-old previously healthy male, human immunodeficiency virus (HIV)-negative, presenting with headache, fever, agitation and slurred speech, who was ultimately diagnosed with tuberculous meningoencephalitis confirmed by cerebrospinal fluid polymerase chain reaction positive for Mycobacterium tuberculosis complex. After initiation of a standard antitubercular therapy combined with glucocorticoids, the patient experienced an initial neurological improvement. However, after 3 months of therapy, he had a major stroke with neurological deterioration, clinically and radiologically attributable to a paradoxical deterioration or an immune reconstruction syndrome as described in HIV-positive patients. Due to the persistence of inflammatory symptoms and radiological evidence of worsening tuberculomas despite ongoing antituberculosis therapy, off-label use of the tumour necrosis factor (TNF) inhibitor infliximab was initiated. The patient received three doses of infliximab at 5 mg/kg at monthly intervals, which led to marked clinical and radiological improvement. Follow-up magnetic resonance imaging showed regression of lesions, and the patient was eventually discharged with a significant recovery of motor and speech functions. This case underscores the potential of TNF inhibitors in managing severe cases of paradoxical deterioration in patients with tuberculous meningitis, challenging existing treatment paradigms and suggesting a need for further research into the pathophysiology and treatment of this condition.

Efficacy and Safety of Systematic Corticosteroids treatment among HIV-Positive Patients with Tuberculosis: a systematic review and meta-analysis of randomized controlled trials.

The efficacy and safety of corticosteroids in patients with human immunodeficiency virus (HIV) and tuberculosis (TB) remain controversial. PubMed, Embase, Web of Science, and the Cochrane Database were searched on September 19, 2024. The primary outcome was all-cause mortality, while secondary outcomes included serious adverse events. A random-effects model calculated risk ratios (RR) with 95% confidence intervals (CIs). Seven RCTs involving 1,410 HIV-positive TB patients were included. Corticosteroid use was not significantly reduce all-cause mortality (RR = 0.91, 95% CI: 0.79-1.04, P = 0.17) and did not significantly increase serious adverse events (RR = 0.96, 95% CI: 0.82-1.13, P = 0.63). This meta-analysis of seven RCTs involving 1,410 HIV-positive TB patients found that corticosteroid treatment neither significantly reduced all-cause mortality nor increased serious adverse events. Further large-scale RCTs with extended follow-up are needed to explore potential benefits in subgroups, optimize treatment protocols, and inform clinical guidelines.

PECULIARITIES OF FATAL CASES IN HIV-INFECTED PATIENTS WITH CENTRAL NERVOUS SYSTEM LESIONS IN TUBERCULOSIS INPATIENT SETTINGS FOR 2014-2023

Aim of the work is to study the peculiarities of fatal cases of CNS lesions in patients with tuberculosis against the background of HIV infection.Materials and methods. A retrospective analysis of 68 medical histories of tuberculosis patients with HIV infection who died in the CNE "Zaporizhia Regional Phthisiopulmonology Clinical Treatment and Diagnostic Center" for the years 2014-2023 was carried out. An analysis of the anamnesis, clinical and radiological data, laboratory indicators, final clinical and pathological diagnoses was carried out.Results. The mortality rate among HIV-infected people in TB hospitals has a steady downward trend. In 2014-2023, 1234 patients with HIV infection were treated at the CNE "Zaporizhia Regional Phthisiopulmonology Clinical Treatment and Diagnostic Center", 214 (17.3%) died. In 2014, 33 (24.6%) out of 134 HIV-positive patients died, and in 2023, 3 (6.8%) out of 44 HIV-positive patients died. Central nervous system (CNS) lesions among the dead were noted in 68 (31.8%) patients. The study of medical records found that among those who died with CNS lesions, men prevailed - 55 (80.9%), women - 13 (19.1%), young patients - 53 (77.9%), and 15 (22.1%) patients over 45 years of age. In the structure of central nervous system lesions in patients with active tuberculosis, tuberculous meningoencephalitis prevails in fatal cases - 35 (51.5%), a significant share of cryptococcal meningoencephalitis - 18 (26.5%) and progressive multifocal leukoencephalopathy - 9 (13.2%). The main reason that leads to fatal consequences is the late diagnosis of HIV infection - in 26 (38.2%) the number of CD4<50 cl./μl, 36 (52.9%) patients did not receive antiretroviral therapy (ART), 18 (26 .5%) of patients had been taking ART for a year. Improvement of tuberculosis microbiological diagnosis due to the introduction of the Xpert MTB/RIF® (Ultra) test at all levels of the laboratory network, the introduction of a mandatory test for cryptococci, free CT, MRI examination for the diagnosis in HIV-infected patients, improvement of drug-resistant tuberculosis treatment regimens contributed to the reduction of mortality in case of HIV and tuberculosis combination, which was 24.6% in 2014, and 6.8% in 2023.Conclusions. Diagnosis and treatment of CNS diseases in patients with active tuberculosis against the background of HIV infection requires a comprehensive approach: early diagnosis of HIV infection, tuberculosis and lesions of the CNS, improvement of treatment.

Clinical observations of skin Kaposi’s Sarcoma

Kaposi's sarcoma (KS) is an angioproliferative disease of endothelial origin associated with human herpes virus-8 (HHV-8), or Kaposi's sarcoma herpesvirus (KSHV). The disease was first described in 1872 by Moritz Kaposi as a pigmented cutaneous sarcoma localized on the lower extremities. The disease is considered quite rare, but at present there is an increase in the incidence worldwide, due to which there is a growing interest in this problem. Today, it remains the leading skin pathology among HIV-positive patients, occurring in 20%. However, the assessment of the pathological process can be difficult, and the diagnosis may not be made at all, due to atypical clinical manifestations (especially in HIV-negative patients), so the problem of KS diagnostics remains relevant for doctors of any specialty, especially dermatovenerologists and oncologists. Kaposi's sarcoma can affect almost any organ, including the skin. The most common localization is on the skin of the extremities and face. Clinical manifestations are rashes in the form of spots, nodules, plaques, nodes. Kaposi's sarcoma is classified according to clinical and epidemiological forms: classical, endemic, epidemic and iatrogenic. Recently, a fifth form has been described, called non-epidemic KS, which is observed in HIV-negative MSM (men who have sex with other men). These clinical cases demonstrate an atypical clinical course of Kaposi's sarcoma of the skin with the absence of HIV-1, HIV-2 and HHV-8 in the blood of the presented patients.

Photogallery. Fungal lesions of skin and nails infections in HIV-associated immunodeficiency

Against the background of any immunodeficiency, including that caused by HIV infection, the risk of developing superficial and invasive fungal diseases increases. Among people living with HIV, the most common fungal skin lesions are candidiasis, rubromycosis, and pityriasis versicolor. As immunosuppression worsens in HIV-positive patients not on antiretroviral therapy, the frequency and severity of mycoses increases. Thus, rubromycosis can spread beyond the feet, covering large areas of skin; sometimes the smooth skin of the hands, large folds, and areas of long hair growth are affected. In this case, the peripheral inflammatory ridge along the edge of the lesions, characteristic of rubromycosis, is sometimes absent. According to some reports, over half of patients in the secondary disease stage of HIV infection suffer from onychomycosis. The progression of the disease often occurs in a short time. In addition to the nail plates of the feet, the nails on the hands are often affected. In patients with HIV infection who do not receive antiretroviral therapy, difficult-to-treat onychomycosis occurs. Cryptococcosis is an opportunistic mycosis caused by yeast-like fungi Cryptococcus spp. It usually develops in HIV-positive individuals with a CD4+ T-lymphocyte level of less than 100 cells/μl. Skin lesions are usually secondary and indicate cryptococcal dissemination. Dermatological manifestations of cryptococcosis are varied. These may include papules and nodules surrounded by erythema and prone to ulceration, vesicular, pustular, herpetiform, acne-like rashes, ulcerative-necrotic lesions. We present to your attention a photogallery of cases of fungal skin lesions that developed against the background of HIV-associated immunosuppression.

PKG1 promotes the HIV-induced proliferation, migration, and fibrosis of vascular smooth muscle cells of hemorrhoids

BackgroundHemorrhoids are very common in patients with human immunodeficiency virus (HIV) infection. The risk of postoperative infection is significantly greater in HIV-positive patients than in HIV-negative individuals, and the wound healing time is significantly prolonged. This study aimed to investigate the role of HIV-associated hemorrhoids from the perspective of vascular smooth muscle cell (VSMC) function.MethodsA total of 24 hemorrhoid tissue samples (note: grade IV hemorrhoids were absence) were collected and subjected to Masson staining to evaluate fibrosis in this study. mRNA and protein levels were monitored by qPCR and WB analysis, respectively. Immunofluorescence was conducted to evaluate PKG1 and α-SMA expression. To establish a cell model in vitro, VSMCs were stimulated with envelope glycoprotein (gp) 120, which is a type of HIV envelope protein. Cell proliferation was assessed via a CCK-8 assay and EdU staining. Moreover, a wound healing assay was performed to assess cell migration.ResultsOur data confirmed that fibrosis was present in hemorrhoid tissues from HIV-infected patients and that PKG1 expression was upregulated. Moreover, the administration of HIV gp120 promoted the proliferation and migration of VSMCs. Similarly, fibrosis-related markers (α-SMA, MMP2, MMP3, and TIMP1) were markedly upregulated. However, silencing PKG1 inhibited the proliferation, migration, and expression of fibrosis-related markers in gp120-challenged VSMCs.ConclusionThe present research revealed that PKG1 regulated the proliferation, migration, and fibrosis of VSMCs, thereby exerting detrimental effects on HIV-associated hemorrhoids.

HIV seropositive disclosure and associated factors among adult HIV positive clients in public health facilities in East Wollega Zone, Oromia Regional State, Western Ethiopia.

Disclosure of HIV-seropositive is important for HIV prevention and maintenance of health for people living with HIV and the community at large. Although HIV seropositive disclosure is mandatory for access to care and treatment, there is a paucity of data in the study setting. This study aimed to assess the magnitude of HIV Sero Positive Disclosure and associated factors among adult HIV positive clients in public health facilities in the east wollega zone, Oromia Regional State, Western Ethiopia, in 2023. A facility-based cross-sectional study design was conducted among 250 adult HIV-positive clients in public health facilities in East Wollega Zone. Systematic sampling was used to select the study participants. Data were collected from February 1 to April 15, 2023, using a structured, pretested, interviewer-administered questionnaire and reviewing patient cards using a checklist. Data were entered into Epi Data version 3.1 and exported to SPSS version 25 for analysis. Bivariable and multivariable logistic regression analyses were done. In bivariable analyses, variables with a P-value <0.25 were candidates for the multivariable model; in the multivariable model, significant associations were declared at a P-value < 0.05 and reported by an adjusted odds ratio along with a 95% confidence interval. The magnitude of HIV seropositive disclosure to at least one person was found to be 68.2% (95%CI = 62.5%, 73.9%). HIV seropositive disclosure was significantly associated with being married ((AOR = 5.47, 95%CI: 2.87-10.43), low knowledge level (AOR = 0.095, 95% CI = 0.017-0.54), and perceived community discrimination (AOR = 0.192, 95% CI = 0.050, 0.74). This study reveals that HIV seropositive disclosure was low among the adult population living in the study area as compared to the other study findings. Disclosure of seropositives was significantly associated with marital status, knowledge level about the importance of disclosure, and perceived discrimination in societies. Healthcare providers and HIV prevention programme planners should provide health education about the importance of HIV disclosure and the stigma against HIV-positive patients by increasing society's awareness through appropriate channels.

COMPREENDENDO A INTERSEÇÃO ENTRE HIV/AIDS E PNEUMONIA: UMA ANÁLISE ABRANGENTE DA LITERATURA

INTRODUCTION: The relationship between HIV/AIDS and pneumonia is complex and multifaceted. Individuals infected with HIV have a significantly higher risk of developing pneumonia, caused by both bacterial and viral agents, due to immune suppression from the virus. OBJECTIVE: To identify in the literature the relationship between HIV/AIDS and pneumonia in the context of nursing care. MATERIALS AND METHODS: This is an integrative literature review conducted in the MEDLINE, LILACS, and BDENF databases, using the descriptors: “HIV seropositivity,” “Pneumonia,” and “nursing care.” The descriptors were combined using the boolean operator AND, covering the period from 2018 to 2024. RESULTS: The study found that HIV-positive patients tend to experience a subacute progression of Pneumocystis jirovecii pneumonia (PCP), while immunocompromised patients without HIV face rapid progression, with a higher risk of respiratory failure and mortality. CT scans showed ground-glass opacities and elevated lactate dehydrogenase levels. Non-HIV patients had longer treatment delays and higher hospitalization and mortality rates. Lymphopenia, steroid use, and pneumothorax were associated with 60-day mortality. The incidence of bacterial pneumonia in people living with HIV decreased, linked to improved CD4 counts. Children with HIV showed higher mortality from coronavirus-related pneumonia. CONCLUSIONS: Future research should expand epidemiological surveillance, explore new therapies, and investigate co-infections in at-risk groups, particularly children. Additionally, strengthening public health policies and promoting prevention education are essential to improve clinical outcomes in vulnerable populations.

Prevalence of major INSTI and HIV-1 drug resistance mutations in pre- and antiretroviral-treated patients in Indonesia

Indonesia has one of the highest HIV infection rates in Southeast Asia. The use of dolutegravir, an integrase strand transfer inhibitor (INSTI), as a first-line treatment underscores the need for detailed data on INSTI drug resistance mutations (DRMs). Currently, there is a lack of comprehensive data on DRMs INSTI and other HIV drug resistance in Indonesian patients, both pre- and post-treatment. The aim of this study was to identify the subtypes and drug resistance mutations of the protease, reverse transcriptase, and integrase genes in both treatment-naive and ARV-treated patients in Bandung, West Java, Indonesia. A cross-sectional study was conducted involving HIV-positive patients at Hasan Sadikin Hospital, Bandung, Indonesia, from September 2022 to January 2023. The patients were categorized into two groups: ARV-treated and pre-treatment patients. Peripheral blood mononuclear cells (PBMCs) were processed for DNA extraction, followed by amplification and sequencing of the pol gene to detect mutations and subtypes. The study found that the predominant subtype was CRF01_AE, accounting for 85.4% and 69% of pre-treatment and treated patients, respectively, followed by recombinant forms such as A1/CRF01_AE, CRF01_AE/CRF02_AG, subtype B, and other subtypes. Among ARV-treated/INSTI-naive patients, major INSTI DRMs R263K and Y143H were identified, while pre-treatment patients exhibited accessory integrase DRMs. The most common DRMs detected were non-nucleoside reverse transcriptase inhibitor (NNRTI) DRMs, with prevalences of 14.6% and 7% in pre-treatment and ARV-treated patients, respectively. In conclusion, CRF01_AE emerged as the predominant subtype in both pre-treatment and ARV-treated patients in Bandung, underscoring the necessity for ongoing surveillance of integrase DRMs, particularly given the presence of major INSTI DRMs in patients undergoing INSTI treatment.

Brief communication: coagulation profiles of HIV positive patients on antiretroviral therapy (ART) at the Mampong Municipal Hospital, Ashanti-Region, Ghana: a case control study

This study aimed to ascertain how the current two ART regimens used in Ghana affected HIV patients’ coagulation profiles. A case-control study was conducted on 102 HIV positive patients at the Mampong Municipal Hospital. Coagulation parameters measured showed APTT was normal in majority of ART-experienced participants but prolonged in majority of ART-naïve participants. The mean platelet count was significantly higher in ART-experienced participants. No significant differences were found between the coagulation profiles of ART-experienced patients on two different drug regimens. In conclusion, current ART can enhance the coagulation profiles in HIV-infected patients, by improving platelet count and APTT.

Predictors of All-cause Mortality among Hospitalized HIV Patients in Kazakhstan: a Retrospective Study

&lt;b&gt;Aim&lt;/b&gt;: This paper examines the predictors of all-cause mortality among hospitalized HIV-positive patients in Kazakhstan.&lt;br /&gt; &lt;b&gt;Material and methods&lt;/b&gt;: The study uses baseline data from patient hospital discharge records derived from the Unified Electronic Healthcare System of Kazakhstan (UNEHS) between 2014 and 2019. Artificial intelligence technology was utilized to extract data from the discharge records. Patients were included based on their first hospitalization, and they were subsequently monitored until their discharge or occurrence of death.&lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;: The study revealed that females had a 2.06-fold higher risk of all-cause mortality compared to males. After adjustments in the Cox proportional hazard model, age, intravenous drug use (IDU), and anemia were observed as independent predictors of mortality within the patient cohort.&lt;br /&gt; &lt;b&gt;Conclusions&lt;/b&gt;:&amp;nbsp; Findings of this study emphasize the need to enhance efforts to prevent late HIV diagnosis by improving access to testing and treatment for those affected, and to strengthen potential for developing risk factors reduction strategies.

Clinical characteristics of HIV-associated tracheobronchial Talaromyces marneffei infection in seven patients in Guangxi, China.

Tracheobronchial Talaromyces marneffei (T. marneffei) infections among HIV-infected patients are rare. To improve understanding, we analyzed the clinical features, immune mechanisms, treatment, and prognosis of these patients. We collected clinical information from HIV-positive patients with talaromycosis admitted to the Fourth People's Hospital of Nanning from January 2015 to June 2022. Patients who presented with culture and/or histopathological proof of tracheobronchial T. marneffei infection were included. A total of 108 patients with respiratory infections who underwent bronchoscopy were enrolled. Seven patients with tracheobronchial T. marneffei infection, all of whom were men with a median age of 48 years (range 39-50 years), were analyzed. Cough, sputum, fever, and weight loss were the most common symptoms. The total white blood cell count was normal or decreased, and all lymphocyte counts were decreased. All patients had reduced CD4+ T-cell counts, with values less than 50 cells/µL. The chest CT imaging signs included patchy signals or large areas of exudation, bronchial stenosis and occlusion. This was different from the lack of bronchial involvement. Endoscopically, the trachea and bronchial mucosa showed congestion, edema, surface attachment, nodules, lumen stenosis, obstruction, etc. T. marneffei spores were found via bronchial mucosal pathology in all 7 patients. Five patients were initially treated with intravenous infusion of amphotericin B for 2 weeks, followed by oral itraconazole capsules (200mg) twice daily, and two patients were initially treated with itraconazole. Six patients were remission, and 1 died. The clinical features of trachea invasion and nontracheal invasion are not unique, but chest CT reveals manifestations such as masses, solid shadows, and bronchial stenosis/obstruction. Bronchoscopy should be performed if possible, and the presence or absence of trachea T. marneffei infection should be confirmed. Antiviral therapy combined with antifungal therapy can improve patient prognosis.

Assessment of Some Micronutrients and Vitamins of HIV Positive Patients in South-South Nigeria

Background: Human Immunodeficiency Virus (HIV) infection continues to be a serious health issue in most parts of the world, with a global prevalence of 0.7% among adults, the majority being in developing countries with limited healthcare resources. Objective: The objectives of this study was to determine the Iron, calcium, zinc, copper, Vitamins D and B12 of HIV positive subjects compared with the control, with respect to gender, age and with respect to duration of treatment. Materials: A total of fifty (50) HIV-positive subjects and fifty (50) HIV-negative subjects (control) were used in this study. Zinc, iron and calcium were evaluated using atomic absorption spectrophotometer, Vitamins D and B12 was done using ELISA, while calcium was estimated using O-cresolphthalein complexone method. The results were presented in tables and chart as mean ± standard deviation. Statistical analysis was done using one way Analysis of Variance (ANOVA) and Student’s t-test using Statistical Package for Social Sciences (SPSS) version 21.0. A p-value of &lt;0.05 was considered significant. Results: Among the study population, 23 (46.0%) were males and 27 (54.0%) were females. With respect to age, 29 (58.0%) were aged 20 – 40 years, while 21 (42.0%) were aged 41 years and above. Based on treatment period, 28 (56.0%) were less than one year, while 22 (44.0%) were more than one year. Among the control subjects, 32 (64.0%) were males and 18 (36.0%) were females. With respect to age, 24 (48.0%) belonged to age group 20 – 40 years, while 26 (52.0%) belonged to age group 41 years and above. The results obtained showed that Calcium, zinc, copper, Iron, Vitamins B12 and D were significantly lower in HIV positive subjects compared with control (p&lt;0.05). Calcium, Iron, Vitamins B12 and D were significantly lower (p&lt;0.05) in age group 41 years and above in comparison with age group 20 – 40 years. Calcium, Iron, Vitamins B12 and D were significantly (p&lt;0.05) higher in HIV positive subjects undergoing treatment for over a year compared with those undergoing treatment for less than one year. There was a significant positive correlation between Calcium and Iron (r=0.840, p=0.000), Calcium and Vitamin B12 (r=0.744, p=0.000), Calcium and Vitamin D (r=0.825, p=0.000), Iron and Vitamin B12 (r=0.743, p=0.000), Iron and Vitamin D (r=0.765, p=0.000) and Vitamin B12 and Vitamin D (r=0.562, p=0.000). Conclusion: The study concludes that the decrease in vitamins and micronutrients that accompanies HIV infection suggests a potentially important role of nutritional supplementation and good nutrition in the proper management of HIV/AIDS.

Predicting immune risk in treatment-naïve HIV patients using a machine learning algorithm: a decision tree algorithm based on micronutrients and inversion of the CD4/CD8 ratio.

Micronutrients have significant functional implications for the human immune response, and the quality of food is a major factor affecting the severity and mortality caused by HIV in individuals undergoing antiretroviral therapy. A decrease in CD4 lymphocyte count and an increase in CD8 lymphocyte count are the hallmarks of HIV infection, which causes the CD4/CD8 ratio to invert from a normal value of >1.6 to <1.0. In this study, we tried to analyze whether the nutritional status of HIV-positive patients has an impact on the CD4/CD8 ratio inversion by utilizing a machine learning (ML) algorithm. In this study, 55 confirmed HIV-positive patients who had not started their anti-retroviral therapy were included after obtaining their informed, written consent. Moreover, 55 age-and sex-matched relatives and caregivers of the patients who tested negative in the screening were enrolled as controls. All individual patient data points were analyzed for model development with an 80-20 train-test split. Four trace elements, zinc (Zn), phosphate (P), magnesium (Mg), and calcium (Ca), were utilized by implementing a random forest classifier. The target of the study was the inverted CD4/CD8 ratio. The data of 110 participants were included in the analysis. The algorithm thus generated had a sensitivity of 80% and a specificity of 83%, with a likelihood ratio (LR+) of 4.8 and LR-of 0.24. The utilization of the ML algorithm adds to the limited evidence that currently exists regarding the role of micronutrients, especially trace elements, in the causation of immune risk. Our inherent strength lies in the fact that this study is one of the first studies to utilize an ML-based decision tree algorithm to classify immune risk in HIV patients. Our study uniquely corroborated the nutritional data to the immune risk in treatment-naïve HIV patients through the utilization of a decision tree ML algorithm. This could subsequently be an important classification and prognostic tool in the hands of clinicians.

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.

The prevalence of Tuberculosis in HIV patients and their correlation with CD4+ count in a tertiary care hospital in Rishikesh, gateway to the Himalayas

IntroductionTuberculosis is the most common serious opportunistic infection in HIV-positive patients. TB can occur at any time during the course of HIV infection. The estimated number of people living with HIV in India in 2019 was 23.48 lakh. With an estimated 2.5 million cases, or 195 cases per 1 lakh people, India has the highest incidence of tuberculosis cases worldwide, accounting for about 23% of all cases, according to MOHFW India. Information about HIV/TB co-infection is still scarce in India, especially in the hilly areas of Uttarakhand. Material and methodsIn this retrospective study, subjects are the patients who are diagnosed with MTB in HIV-positive patients of all age groups and sex and were followed up from January 2021 till August 2022 in a tertiary referral hospital AIIMS Rishikesh.Diagnosis of MTB was based on clinical, laboratory, and neuroimaging signs, and HIV was based on dot blot, immunochromatographic, and chemiluminescence assay. ResultA total of 520 patients screened for HIV were positive. Out of which 145 were MTB in which 133 had pulmonary tuberculosis and 12 had extra-pulmonary tuberculosis. The patients' average age was 35.5 years. Among males, females and transgender, 97 (66.89%), 46 (31.72%) and 2 (1.38%) have both TB and HIV co-infections respectively.Mean CD4 count prior to ATT was 350.21, After completion was 486.48. The prevalence of Tuberculosis among HIV positive cases was 23.8%.Baseline and latest CD4 count was conducted before and after ART and ATT treatment. It was observed that there was significant increase in the CD4 count after treatment. ConclusionHIV co-infection with TB is higher in this region. There is a role of CD4+ count in the prognosis and progression of the disease. More strategic measures are required for early diagnosis and treatment of HIV to combat MTB.

Experience of Using Delamanid in the Treatment of Multiple Drug Resistant Tuberculosis

The objective: to evaluate treatment results in MDR TB patients when delamanid is added to the treatment regimen.Subjects and Methods. 91 patients with multiple drug resistant pulmonary tuberculosis were included in the study, of which 36 people (39.6%) were HIV positive. Patients were divided into four comparison groups depending on HIV status and inclusion of delamanid in the treatment regimen. Groups receiving delamanid included only patients in whom bedaquiline or linezolid had been discontinued due to adverse reactions.Results. The results of treatment of MDR TB when delamanid is added to the chemotherapy regimen during the intensive phase, indicate its high effectiveness and safety including HIV positive patients.