HIV-seropositive Patient Research Articles

Levetiracetam-Induced Pancytopenia in an HIV Seropositive Patient With SARS-CoV-2

Levetiracetam is a widely used and safe antiepileptic drug, and levetiracetam-induced pancytopenia is an uncommon adverse effect. We present a patient case of a middle-aged man with seizures who developed profound pancytopenia within 4 days of starting levetiracetam. We suspected levetiracetam-induced pancytopenia, withdrew the levetiracetam, and started our patient on an alternative medication, which improved his blood count within 24 hours. This is the first patient case demonstrating levetiracetam-induced pancytopenia in an adult with coexisting HIV and SARS-CoV-2 infections, which did not contribute to his pancytopenia. Physicians should be cognizant of this adverse effect when prescribing levetiracetam to treat seizures.

Successional occurrence of two papulosquamous disorders in HIV positive patient: a rare case report

<p class="abstract">Presentation of two papulosquamous disorders in a same individual is rare condition till date. Independently, psoriasis and Lichen planus (LP) are common inflammatory skin conditions affecting around 2-3% and 1% of HIV (Human immune deficiency) positive population respectively. As reviewed in the literature, psoriasis may be independently associated with other autoimmune conditions like vitiligo, alopecia areata, lichen planus, and discoid lupus erythematosus. In this article, we presented a case report of a HIV seropositive patient who suffered from psoriasis and lichen planus. The coexistence of psoriasis and lichen planus in one individual is rare and underreported in literature. Psoriasis or lichen planus may be the presenting feature of HIV infection and tends to be more severe, to have atypical presentations. Psoriasis and lichen planus can be coexistent or successionally appear one after other in one individual though rare presentation. High index of suspicion is always required while dealing with papulosquamous lesions in PLHIV.</p><p> </p>

Kaposi's Sarcoma and Lymphoedema in a HIV Sero-positive Patient: A Case Report and Literature Review

Kaposi sarcoma (KS) is one of the most common neoplasms diagnosed in HIV- seropositive subjects. KS is an angioproliferative disorder of endothelial origin and is a locally aggressive multicentric mucocutaneous malignant neoplasm. Aggressive HIV-KS is associated with increased HHV8 viral load, disseminated lesions, and intraoral exophytic lesions, and may also present with facial lymphoedema which may be life-threatening or mild.
 A 26 -year-old, male, presented with severe oral pain and facial swelling. He had multiple oral lesions and an incisional biopsy confirmed Kaposi sarcoma. A multiple site incisional biopsy and immunohistochemistry for HHV8 was done and based on the clinical, histopathological, and immunohistochemical results a diagnosis of HIV associated oral and cutaneous KS with severe lymphoedema was confirmed.
 This aim of this case presentation is to describe a case of immunodeficiency virus-related lymphadenitis, oral and cutaneous KS associated with the complication severe lymphoedema in a HIV infected patient who was not on HAART therapy for three years after being diagnosed with HIV.

Leucoplasia pilosa: revisão da literatura e apresentação de um caso

The autors present a report of a case of about hairy leukoplakia that have relationship with a HIV seropositive patient. We will discuss the clinicar and histopathoiogical aspects of these lesions. It is stressed the role of the dentist in the of AIDS related oral lesions.

True “costs” of neurological illness in human immunodeficiency virus patients in a “free” health facility

Objectives: Human immunodeficiency virus (HIV) infection and neurological illness cause heavy financial burden to the patients. The economic costs of each of the disease have been reported in many studies, but the toll of both together on the patients has not been studied clearly. As neurological illnesses are seen in up to one-third of HIV patients, the combined costs need to be understood. Even with free public health services, there are out of pocket expenditures on the patients. Material and Methods: In the tertiary Government General Hospital, Guntur in India, we studied the out-of-pocket costs of time and money borne by 50 HIV-seropositive individuals hospitalized for a neurological illness during April and May 2019. We obtained data from the patients and caregivers by face-to-face oral questionnaires. Results: The median duration of HIV infection was 2.5 (IQR 0.4–7.8) years. A high proportion of our patients (20/50) was diagnosed with tuberculous meningitis. The total median time lost by each HIV-seropositive patient due to neurological illness (private consultation, travel, and hospital stay) was 27.5 (8.7–134.3) days. The total median financial burden due to neurological disease requiring hospitalization (travel, food and medicine, wages lost, private consultation expense, and loans incurred) on each patient was ₹19,150 (855–59881). Conclusion: HIV patients with neurological illness are burdened by heavy costs of time and money. They are forced into debt and lose substantial wages, most of it due to private consultation.

Health-Related Anxiety in the Management of Oral Soreness in an HIVSeropositive Patient

The number of people living with HIV (PLHIV) has been increasing since the first known case in the early 1980s. However, PLHIV can also experience comorbidities, such as health anxiety. In the oral cavity, anxiety is often associated with the etiology of parafunctional habits. Anxiety can be measured using self-administered instruments, such as the Hospital Anxiety and Depression Scale (HADS) and Short-Health Anxiety Inventory (SHAI), which is specifically used in the medical setting. Objectives: We are describing a case of HIV positive patient with health anxiety who presented to the oral medicine clinic in our hospital with a complaint of discomfort on his lateral sides of the tongue. Case Report: A 35-year-old male patient came to the oral medicine clinic complaining of discomfort on his tongue, which presented for one week. The patient was alarmed by two bumps seen on the right lateral side of his tongue and soreness on the left lateral side. Nystatin oral suspension was prescribed by a medical doctor but discontinued by the patient. The patient was positive for HIV and took ART routinely. Extraoral and intraoral examinations showed unremarkable findings except slightly enlarged and erythematous foliate papillae on the left lateral side of the tongue. The patient was prescribed an antiseptic mouth rinse. After several days, his symptoms had dissipated. Since the patient reported anxiety regarding his health and HIV status, we asked the patient to complete the HADS and SHAI self-assessment tools to measure his level of anxiety. The patient was shown to have anxiety using the SHAI (total score = 21). Conclusion: Health anxiety is a condition that an individual misinterprets as a benign bodily sensation. The management of this type of patient involves addressing the local predisposing factor of the oral complaint and maintaining oral hygiene, followed by an evaluation of health anxiety for the basis of referral to a psychological expert.

Burkitt lymphoma presenting with nasopharyngeal mass and generalized lymphadenopathy in a HIV-positive patient

Burkitt lymphoma is an aggressive B-cell neoplasm arising from the germinal center B cells. Clinically, it exists in three forms: endemic, sporadic, and immunodeficiency associated. Immunodeficiency-associated Burkitt lymphoma is usually extranodal and occurs with a CD4 count more than 200 μl. We report a retrospective study of a 47-year-old male patient, seropositive for HIV infection, presenting with nasopharyngeal mass and generalized lymphadenopathy. His CD4 count was 192 cells/μl, and lactate dehydrogenase was high. Diagnosis was established by biopsy, immunohistochemistry, and fluorescence in-situ hybridization. He was treated with chemotherapy. The disease progressed to involve central nervous system despite treatment. He received palliative radiotherapy and was stable at 11-month follow-up. This report highlights the uncommon clinical presentation, heavy disease burden, and progression of the disease in a HIV seropositive patient.

Percutaneous Nephrolithotomy in the supine flank free modified position for the removal of a 3 year Double-J ureteral stent in a horseshoe kidney

Horseshoe kidney is one of the most common congenital renal abnormalities with increased incidence of stone formation. We present a case of an HIV seropositive patient with a both-ends encrustated 3 year forgotten DJ stent and a staghorn stone in the left moiety of a horseshoe kidney. He was treated with percutaneous nephrolithotomy in the supine flank free modified position and simultaneous cystolitholapaxy. Supine percutaneous nephrolithotomy is safe and feasible in horseshoe kidney and facilitates simultaneous thansurethral access for cystolitholapaxy.

Complex drugs interactions in a HIV-seropositive heart transplant recipient

Highly active antiretroviral therapy has led to greater life expectancy for human immun-deficiency virus (HIV)-positive patients. This was a report of 11 years of follow-up of an HIV-seropositive patient who underwent heart transplantation in 2006, with emphasis on the management challenges of complex drug interactions over time.

Prevalence of rifampicin resistant mycobacterium tuberculosis and associated factors among presumptive tuberculosis patients in eastern Uttar Pradesh: a cross sectional study

Background: Drug resistant tuberculosis threatens global TB control and is a major public health problem in several countries and India has the highest tuberculosis in the world. The rifampicin resistance is a good predictor of multidrug resistant tuberculosis. The aim of this study was to determine the prevalence of rifampicin resistance M. tuberculosis and associated factor among presumptive tuberculosis patients in eastern Uttar Pradesh.Methods: A cross-sectional study was conducted from October 2016 to September 2017. Detection of M. tuberculosis and resistance to rifampicin was performed using Gene Xpert MTB/RIF assay. Data was collected using pre-structured questionnaire by face to face interview. The chi-square test was used to assess the statistical significance of each ratio, p<0.05 was considered significant.Results: Out of 510 patients, Mycobacterium tuberculosis was detected in 168 (32.9%). Out of these 168 patients, the prevalence of rifampicin resistance tuberculosis was 44 (26.1%). It was higher among male 38 (30.6%) than female 6 (13.6%). Regarding age distribution, maximum numbers of rifampicin resistance patients were in the age group of 20-40 years 36.7%. The prevalence of rifampicin resistance was 36 (27.6%) and 8 (21.0%) in pulmonary and extra-pulmonary respectively. Out of 44 rifampicin resistant cases, 39 (37.8%) were previously treated and 5 (7.6%) cases were treatment naïve patients. In this study, among presumptive DRTB cases, new 2 (11.7%), relapse 13 (39.3%), failure 23 (46.0%), loss to follow-up 1 (10.0%) and MDR contact 1 (20.0%) respectively were rifampicin resistant and one HIV seropositive patient was found to be rifampicin resistant.Conclusions: Previously treated cases were significantly associated with rifampicin resistance tuberculosis. The Gene Xpert is a good equipment for rapid detection and management of drug resistant tuberculosis for both pulmonary as well as extra-pulmonary tuberculosis.

Disseminated rectal tuberculosis in an HIV-seropositive patient: A case report

Disseminated rectal tuberculosis in an HIV-seropositive patient: A case report

Che cosa so di......HIV: riflessioni sull'andamento di una pandemia

HIV infection natural history is extremely changed, today. When we observed HIV virus infection for the first time in 80’s, this was a dramatic diagnosis and people were frightened by patients affected. This behaviour explained the great diffusion of HIV infection in the past time and the usefulness of prevention strategy. Instead of, in the last two decades, global prevention strategies explained how the infection could be transmitted and they reduced the HIV seropositive patient’s stigma. In 90’s, the HIV infection turned from a lethal pathology into a chronic infection. In that period infact, we learn how mixed together some old and new drugs, that combined became HAART, the first strongly active HIV therapy. Nowadays, the HIV infection is considered as a chronic one. In 2014, there were 35.000.000 patients living with HIV infection in the world. More than 40.000.000 persons died in the world during this epidemic disease. In the past, the virus transmission was especially related to parenteral transmission, intravenous drug use and homosexual behaviours. Today, the most important way of transmission is the sexual one. The reduction of viral transmission in intravenous drug users population is obviously related to a great prevention work by specialized services, who take care of that kind of patients (Servizio per le Dipendenze Patologiche: Ser.D). In the last two decades, we observed a reduction of the new HIV seroconversions and of the AIDS related deaths. The HAART therapy is now available also in the poorest parts of the world, like Africa, for example. WHO encourages all the Countries to defeat HIV infection at least in 2030, but this project seems to be an utopic one.

Pulmonary candidiasis and CD4 count in HIV positive patients seen in Jos, north central Nigeria

Background: Accurate and reliable diagnosis of HIV opportunistic infections plays a central role in effective HIV intervention programmes. Pulmonary infections are the leading cause of morbidity and mortality in HIV infected individuals.Objectives: We set out to determine the prevalence of Pulmonary candidiasis by isolating Candida species from the sputum of HIV sero-positive patient’s presenting to hospital with complaint of cough for more than two weeks and related the level of CD4 count to Pulmonary candidiasis.Methods: Using sterile wire loop, each sputum sample was inoculated into duplicate SDA (Thermo Scientific, UK); one tube without antibiotics, another tube supplemented with Chloramphenicol (0.05%) and Cycloheximide (0.5%) antibiotics. The patient’s CD4 count was determined using a Cyflow machine (PARTECR, Germany).Result: Fifty two (54.2%) female and 44(45.8%) male HIV positive subjects were compared with a control group made up of, 52(54.2%) female and 44(45.8%) male HIV negative subjects. Twenty one (21.9%) HIV positive subjects had Candida species in their sputum samples compared to 12(12.5%) in the HIV negative subjects. Among HIV positive subjects, 17(17.7%) had Candida albicans isolated from their sputum, 11(11.5%) of whom had a CD4 count of <200 cells/ul.Conclusion: We concluded that, there is a risk of pulmonary candidiasis occurring in HIV infected patients with CD4 count <200cells/ul and that, Candida species contributes to chronic cough experienced by HIV infected patients. We recommend that HIV positive patients who have chronic cough and whose CD4 count is <200cells/ul be placed on systemic antifungal medication.Keywords: Candida, Cough, Nigeria, Sputum

Mycotic Infections in Bronchopulmonary Diseases

Background: Recently pulmonary mycotic infections have gained increasing recognition in the field of infectious diseases and pose a difficult challenge.Since clinicians now see an increasing number of immuno-compromised patients, high index of suspicion is necessary for timely diagnosis and treatment of mycotic infections. Aim: The study was designed to document the prevalence and sensitivity pattern of fungal pathogens associated with bronchopulmonary infections. Material & Methods: The study includes 60 clinically diagnosed cases of bronchopulmonary infections along with 20 normal healthy individuals taken as control. Samples collected from cases and controls were processed to examine the presence of fungal pathogens and their sensitivity pattern was studied. Results: 40 fungal pathogens were isolated. Majority male patients (70%) were affected, among them(50%) belong to the age group of (41-60 years). Among the isolated fungal pathogens Candida spp predominated(40%) followed by Aspergillus spp (32.5%).One spp of Penicillium marneffei was isolated from an HIV sero positive patient. Two non albicans Candida spp were isolated from controlgroup. Among the antifungals used all the isolates were resistant to Trimethoprim (Tr),Co-trimazine(Cm),Co-trimoxazole(Co) and Polymyxin-B(Pb). All spp of Candida, Aspergillus and Penicillium were found to be sensitive to Clotrimazole(Cc).But Fusarium and Mucor spp were resistant to all the antifungal agents used. Conclusion: Hence a great awareness is required for selective isolation and identification of fungi along with their antifungal susceptibility pattern.

Spontaneous Elimination of HCV during the Reactivation of HBV Infection in a HIV-Seropositive Patient: A Case Report

The course of hepatitis C virus (HCV) infection varies widely after initial exposure. Two-third of individuals have persistent viremia and develop chronic hepatitis C. In HCV chronically-infected patients, spontaneous HCV clearance occurs in approximately 0.5%/individual/year. All the case reports describing this fact are associated with changes in host immunity. We report a case of HCV RNA spontaneous clearance concurrently with hepatitis B virus (HBV) reactivation in a patient infected with the human immunodeficiency virus type 1 (HIV-1) and chronically-infected with HCV. Serum HCV RNA became undetectable at diagnosis of HBV reactivation. Nine months after acute hepatitis, serum HBV DNA was no more detectable but HCV RNA load was found to rise again to its pre-hepatitis level.

A case of lichenoid photosensitive eczema in a HIV seropositive patient

Case report A 32 year old female presented with burning and itching sensation with hyperpigmentation over the sun exposed areasface, neck, back and arms. No history of any blisters over skin or hypertrichosis. History of weight loss of more than 6 kgs was documented in a month. Patient’s husband was a driver with history of multiple unprotected sexual exposures with CSW. No history of any oral or genital ulcers, artharlgia, diarrhoeal episodes, evening rise of temperature and cough with expectoration. O/E: Erythematous and edematous plaques present over sun exposed areas. Hyperpigmention with lichenoid hue + over malar region, neck folds ,back and arms Multiple excoriation marks, hyperpigmented papules and plaques present over bilateral arms, legs, and ante cubital fossa.Oral cavity, genital mucosas were normal. No generalised lymphadenopathy. Routine laboratory investigations were normal. Mantoux test, RPR, Chest Xray, USG abdomen pelvis was normal. Skin biopsy was suggestive of interface dermatitis. HIV (1 and 2) ELISA was reactive which was confirmed by Western blot. The CD4 count was 610/cumm.

Immediate Loading With Fixed Implant-Supported Restorations in an Edentulous Patient With an HIV Infection

Oral rehabilitation of edentulous patients with implants that are immediately loaded is a viable treatment alternative today; however, the immediate loading protocol has not been extensively documented in HIV-seropositive patients. This clinical case report presents a surgical and prosthetic implant-supported immediate loading protocol in an edentulous HIV-seropositive patient (CD4 >200 and T4/T8: 0.99). Eight implants were placed in each jaw, and no ridge augmentation procedures were required. All the implants were connected with abutments, and a temporary fixed restoration was placed immediately after surgery. The final fixed reconstruction was cemented after 10 weeks of loading. All implants showed no clinical signs of mobility or infection. Periotest values were evaluated during healing and showed a progressive reduction. Radiological findings showed stable bone levels after an observation period of 4 years. This case report presents an alternative treatment for the oral rehabilitation of an HIV-positive (but disease asymptomatic) edentulous patient. The concept of immediate loading of implants offers advantages when compared with a traditional treatment modality even in immunocompromised patients who are well controlled.

Acute ulcerative lesions in HIV seropositive patient

Acute ulcerative lesions in HIV seropositive patient

Oral candidiasis and AIDS

Human immune deficiency virus [HIV] infected seropositive patient suffer from a lot of opportunistic infection because of defective immune response. The defective immune response in HIV seropositive patient is due to the depletion of CD4 lymphocytes with advancing stages of HIV infections. Oral candidiasis is commonly affecting opportunistic infections in patients. The predominant species affecting is candida albicans. Oral candidiasis is seen in increasing frequency in reduced CD4counts.this article gives an attempt to an over view of oral candidiasis in HIV relationship of oral candidiasis with CD4count.various modalities of diagnosis and treatment of oral candidiasis.

ABSCESOS CEREBRALES PRIMARIOS POR Nocardia farcinica EN UN PACIENTE CON SIDA

Nocardia species are aerobic, Gram positive, partially acid-fast bacilli, acquired through the respiratory tract or the skin. Nocardial organisms disseminate from the primary site of infection from haematogenous source to the brain, especially in immunocompromised patients; less frequently, central nervous system involvement may be primary, in both immunocompetent and immunodeficient subjects. Cerebral nocardiosis is infrequent and present in only 2% of all the brain abscesses. Early diagnosis followed by surgical resection and prolonged antibiotic therapy may improve the poor prognosis and the morbimortality of these patients. Nocardia spp. cause actinomicetomas more frequently than cerebral nocardosis in inmunocompetent hosts. Here we describe an HIV seropositive patient who developed primary cerebral abscesses due to Nocardia farcinica and we include a review of the medical literature.