HIV Stage Research Articles

Highly active antiretroviral therapy and left ventricular diastolic function in children with human immunodeficiency virus infection

Background In the past, cardiovascular involvement did not seem to be a common complication of HIV, but in recent years it has been described more frequently. With the advent of highly active antiretroviral therapy (HAART), the symptoms of cardiac disease has changed, as the number of HIV-infected patients with abnormal diastolic parameters has increased significantly, often presenting as symptomatic rather than asymptomatic.
 Objective To analyze for a possible correlation between HAART duration and left ventricular diastolic function in HIV-infected children. 
 Methods This cross-sectional study was conducted from December 2016 to December 2017 at the Cardiology and Allergy-Immunology Division/Department of Child Health, Universitas Udayana Medical School/Sanglah Hospital, Denpasar, Bali. Subjects with HAART were collected using a consecutive sampling method. The following data were recorded for each subject: age, sex, current stage of HIV, CD4+ level, as well as HAART regimen and duration of use. Transthoracic echocardiography was performed for tissue doppler imaging (TDI) of diastolic function. Spearman’s test was used to analyze the strength of correlation based on normality test results.
 Results This study involved 53 subjects, 21 of whom had impaired diastolic function. There was no correlation between HAART duration and diastolic function in children with HIV infection (r= -0.03; P=0.82).
 Conclusion Diastolic dysfunction is found in children under HAART treatment, but there is no correlation between HAART treatment duration and diastolic dysfunction.

Serum Reproductive hormone levels in male symptomatic HIV/AIDS patients on Antiretroviral therapy negative to Malaria parasite in Nnewi, Anambra State, Nigeria

Background: AIDS is an endemic disease that causes death among young adults worldwide especially in Nigeria.
 Aims and Objectives: This study investigated the serum reproductive hormone levels in symptomatic HIV/AIDS male subjects on ART who are negative to malaria parasite in Nnewi, Anambra State, Nigeria.
 Materials and Methods: A total of 274 adult male participants aged between 18 and 60 years were randomly recruited, and grouped into: symptomatic HIV (stage 11) infected male participants on ART (A: n=69), Symptomatic HIV subjects not on ART (B: n= 69), Asymptomatic HIV positive subjects (C: n= 68) and HIV seronegative subjects (D: n= 68). Serum was used to assay for PSA, LH, FSH, Estrogen, Testosterone, Progesterone and Prolactin levels. Analysis of variance and student t-test were used for data analyses.
 Results: The serum levels of PSA, FSH, Estrogen, Testosterone, Progesterone and Prolactin were significantly different amongst the groups at p<0.05 respectively. There were significantly higher levels of PSA, Estrogen, Progesterone but lower levels of Testosterone and Prolactin in subjects on ART compared with control at p<0.05 respectively. There were significantly higher levels of PSA, FSH, Estrogen,Progesterone but lower levels of Testosterone in subjects not on ART compared with control at p<0.05 respectively.
 Conclusion: The reduction on serum levels of Testosterone and higher levels in FSH, PSA, Estrogen, and Progesterone may reveal presence of hypogonadism, primary testicular failure, prostate abnormalities such as cancer and hyperprogesteronaemia, in symptomatic HIV positives.

Immunological and virological effects of the treatment of acute HIV infection with the use of drugs Nikavir and Tenofovir

23 patients were treated with the acute stage of HIV infection for 8-48 weeks. All patients received antiretroviral therapy with the inclusion of 2 NRTIs and 1 NNRTIs. The first group of 11 people received a regimen with Nikavir, the second — of 12 people — with Tenofovir, in combination with Lamivudine and Efavirenz in standard doses

Body Mass Index, Blood Pressure and Serum Cortisol Level as Stress Index in Symptomatic HIV/AIDS Male Subjects on Antiretroviral Therapy Negative to Malaria Parasite in Nnewi, Anambra State, Nigeria

Background: HIV infection is a risk factor for a variety of endocrine problems. Objectives: This study investigated the body mass index (BMI), Systolic blood pressure (SBP), Diastolic blood pressure (DBP) and serum cortisol level as stress factor/index symptomatic HIV/AIDS male subjects on ART who are negative to malaria parasite in Nnewi, Anambra State, Nigeria. Methods: A total of 274 adult male participants aged between 18 and 60 (42 ±13) years were randomly recruited at the Voluntary Counseling and Testing (VCT) Centre in Nnamdi Azikiwe University Teaching Hospital and grouped based on WHO criteria for staging HIV into symptomatic HIV (stage 11) infected male participants on ART (A: n=69), Symptomatic HIV subjects not on ART (B: n= 69), Asymptomatic HIV positive subjects (C: n= 68) and HIV seronegative subjects (D: n= 68). Blood samples were collected from the participants for the determination of HIV status by immunochromatography and HIV confirmation by Western Blot. Enzyme-Linked Immunosorbent Assay (ELISA) was used to assay for cortisol level. Results: The results showed a significantly increased BMI and decreased mean serum cortisol level in HIV/AIDS seropositive participants on ART than in those, not on ART (p<0.05). Also, the BMI and mean serum cortisol level were significantly decreased and increased respectively in HIV/AIDS seropositive participants not on ART than in Asymptomatic HIV positive subjects and control respectively (p<0.05). However, the mean SBP and DBP did not differ significantly between the groups studied (p>0.05). Conclusion: This study revealed a decreased stress index in HIV/AIDS subjects on ART with hypercortisolism and lower BMI in symptomatic HIV participants, not on ART.
 Keywords: HIV; AIDS; Malaria uninfected male subjects; Cortisol; Blood pressure; Antiretroviral therapy.

Bloodstream infections in patients living with HIV in the modern cART era

Retrospective multicentre study aiming at analysing the etiology, characteristics and outcome of bloodstream infections (BSI) in people living with HIV (PLWHIV) in an era of modern antiretroviral therapy. Between 2008 and 2015, 79 PLWHIV had at least 1 BSI, for a total of 119 pathogens isolated. Patients were mainly male (72.1%), previous intravenous drug users (55.7%), co-infected with HCV or HBV (58.2%) and in CDC stage C (60.8%). Gram-positive (G+) pathogens caused 44.5% of BSI, followed by Gram-negative (G−), 40.3%, fungi, 10.9%, and mycobacteria, 4.2%. Candida spp. and coagulase-negative staphylococci were the most frequent pathogens found in nosocomial BSI (17% each), while E.coli was prevalent in community-acquired BSI (25%). At the last available follow-up, (mean 3.2 ± 2.7 years) the overall crude mortality was 40.5%. Factors associated with mortality in the final multivariate analysis were older age, (p = 0.02; HR 3.8, 95%CI 1.2–11.7) CDC stage C (p = 0.02; HR 3.3, 95%CI 1.2–9.1), malignancies, (p = 0.004; HR 3.2, 95%CI 1.4–7.0) and end stage liver disease (p = 0.006; HR 3.4, 95%CI 1.4–8.0). In conclusion, the study found high mortality following BSI in PLWHIV. Older age, neoplastic comorbidities, end stage liver disease and advanced HIV stage were the main factors correlated to mortality.

"Even if she's really sick at home, she will pretend that everything is fine.": Delays in seeking care and treatment for advanced HIV disease in Kinshasa, Democratic Republic of Congo.

IntroductionHIV prevalence in the Democratic Republic of Congo (DRC) is estimated to be 1.2%, and access to HIV testing and treatment remains low across the country. Despite advances in treatment, HIV continues to be one of the main reasons for hospitalisation and death in low- and middle-income countries, including DRC, but the reasons why people delay seeking health-care when they are extremely sick remain little understood. People in Kinshasa, DRC, continue to present to health-care facilities in an advanced stage of HIV when they are close to death and needing intensive treatment.MethodsThis qualitative study was conducted in one health-care facility in Kinshasa. A total of 24 in-depth interviews with purposively selected health-care workers, patients and care-givers were conducted. Patients were currently or previously hospitalised with advanced HIV, defined as CD4 count <200 cells/μl. Patients included those who had previously started antiretroviral treatment (ART), and those who had not. Participant observation was also carried out. Interviews were audio-recorded, translated from French and Lingala into English, transcribed, coded and thematically analysed using NVivo.ResultsThe main reasons for delaying access to health-care were stigmatisation, religious beliefs and limited economic resources. Stigmatisation meant that people feared disclosing their HIV status and thus did not receive support from their families. Religious leaders were reported to have encouraged people not to take ART. Patients delayed seeking treatment as they could not afford it, and health-care workers believed that staff at other facilities in Kinshasa were delaying HIV diagnoses for economic benefit.ConclusionsDelays in accessing care and treatment linked to stigma, religious beliefs and economic factors contribute to explaining the persistence of advanced HIV within this context. Access to free HIV-testing, ART and treatment of opportunistic infections; counselling; training of health-care workers; support for care-givers and stigma reduction strategies are urgently needed to prevent unnecessary deaths.

Penerapan Data Mining Untuk Mendeteksi Tingkatan Stadium Penyakit Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome (Hiv/Aids) Menggunakan Algoritma Naive Bayes Classifier (Studi Kasus Pada Rumah Sakit Umum Daerah (Rsud) Anutapura Palu)

At Anutapura Palu General Hospital (Hospital) Anutapura Palu to perform stadium detection still using Ms.Excel application with the result of detection is still manually input, to overcome the problem the author aims to make data mining applications to detect the stage of HIV / AIDS by applying Naive Bayes algorithm with output / output result of stadium 1, stadium 2, stadium 3 and stadium 4. The research data was obtained at Anutapura Palu General Hospital (RSU) from 305 HIV / AIDS patients. Existing data were analyzed using Naive Bayes algorithm and using 11 features. Naive Bayes aims to classify data in a particular class, then the pattern can be used to determine the level of stadium suffered by HIV / AIDS patients.

Social and structural factors and engagement in HIV care of sub-Saharan African migrants diagnosed with HIV in the Paris region

ABSTRACTMigrants from sub-Saharan Africa (SSA) are often diagnosed at an advanced stage of HIV, and many of them have harsh living conditions. We aimed to evaluate the entry into care after HIV diagnosis and examine the related social determinants. The ANRS PARCOURS study is a life-event survey conducted in 2012–2013 in the Paris region among. Time between HIV diagnosis of SSA migrants living diagnosed HIV positive in France and HIV care and the determinants was assessed yearly by using mixed-effects logistic regression models. Among a total of 792 participants, 94.2% engaged in HIV care within the year of HIV diagnosis, 4.3% in the following year and 2.5% beyond the second year after diagnosis. The participants were more likely to engage in HIV care during years when they were effectively covered by health insurance and if the HIV test was carried out at the initiative of the doctor. Immigration for economic reasons or owing to threats in his/her country of origin was associated with delayed engagement in HIV care. Additionally, 4.3% of treated participants discontinued HIV care at least once at the time of the survey and more often if diagnosed at an advanced HIV disease stage and financially dependent.

Time delay and associated mortality from negative smear to positive Xpert MTB/RIF test among TB/HIV patients: a retrospective study

BackgroundThe GeneXpert MTB/RIF Assay (Xpert®) is known to be a feasible, effective and a hopeful tool for rapid tuberculosis (TB) diagnosis and treatment. However, little is known about the time delay caused by initial negative sputum smear microscopy (NSSM), but consecutive positive Xpert TB test (PXTBt) and its association with TB mortality in resource-constrained settings. We aimed to estimate the median time delay between initial NSSM but consecutive PXTBt and TB treatment initiation and its association with TB mortality among TB/HIV co-infected patients in Beira, Mozambique.Methodswe used data from a retrospective cohort study of TB/HIV co-infected patients in six TB services in Beira city. The study included all patients that tested NSSM, followed by a PXTBt in the six health centers with TB services during the year 2015. Data were extracted from the laboratory and TB treatment registers. To assess the difference in median time delays between groups, Mann-Whitney and Kruskal-Wallis tests were computed. To analyze the associations between the time delays and TB mortality, logistic regression model was used.ResultsAmong the 283 patients included in the study, median (IQR) age was 31 (17) years, 59.0% were males, 57.6% in the WHO clinical fourth stage of HIV. The median (IQR) values for diagnostic delay, treatment delay and total time delay was 10 (9) days, 13 (12) days and 28 (20) days, respectively. For TB/HIV co-infected patients who tested negative for smear microscopy initially, a total time delay of one month or longer was associated with high mortality (aOR = 12.40, 95% CI: 5.70–22.10).ConclusionOur study indicates that delays in TB diagnosis and treatment resulting from initial NSSM, but consecutive PXTBt are common in Beira city and are one of the main factors associated with TB mortality among TB/HIV co-infected patients. Applying GeneXpert assay as gold standard for HIV-positive patients with suspected pulmonary TB or replacing the sputum smear microscopy by Xpert assay and its availability within 24 h is urgently needed to ensure early diagnosis and treatment, and to maximize the impact of the few resources available in the country.

Mental Health of Persons Living with HIV/AIDS

Introduction: Living with HIV/AIDS can significantly impact a person’s mental health, posing various challenges that extend beyond the physical aspects of the disease. The intersection of HIV/AIDS and mental health presents a complex landscape influenced by a range of factors, including stigma, social isolation, psychological distress, and the implications of a chronic illness. Upon receiving an HIV/AIDS diagnosis, individuals often experience a whirlwind of emotions, such as fear, anxiety, shock, and uncertainty about the future. The stigma surrounding HIV/AIDS can exacerbate these feelings, leading to self-isolation, shame, and a reluctance to seek support or disclose their status due to fear of discrimination or rejection. Aim/Objectives: Impact of gender, age and stages of HIV on mental health among persons living with HIV/AIDS in Rayalaseema region of Andhra Pradesh state. To assess the impact of gender, age and stages of HIV on mental health among persons living with HIV/AIDS. Sample: The subjects of the present investigation are drawn HIV/AIDS persons in ART and ICTC centers in Rayalaseema Region of Andhra Pradesh State of India. Tool: Mental health status inventory designed by Jagadish and Srivastava (1983) was used. Design: There are three independent variables in the investigation and each variable is further classified into two, a 2 × 3 × 4 factorial design was employed. Results: Mean, SD and ANOVA (Analysis of Variance) were calculated. Discussion: Males are good mental health than females. Conclusion: Subjects of 26-35 years are good mental health than the subjects of 46-55 years. Subjects with Primary Infection are good mental health than subjects with Opportunistic Infections/AIDS.

Impact of Anemia on Outcome of HIV-Infected Pediatric Patients: A Prospective Observational Study.

Introduction:Anemia has been widely reported to predict a poorer prognosis for HIV-infected patients, both in terms of progression to AIDS and in survival. This study aimed to determine the etiology of anemia and its immunological correlation in HIV-infected children.Materials and Methods:Four hundred and eighty-nine HIV-infected children were screened, of which 86 HIV-infected children with anemia were enrolled. Standard WHO definitions were used for anemia, HIV staging, and growth parameters. Chi-square test, t-tests, and univariate and multivariate logistic regression analyses were used to analyze the data.Results:Anemia was present in 17.58% (86/489) of HIV-infected children, including 84.6% with moderate anemia, 11.5% with severe anemia, and 2.32% with mild anemia. The mean hemoglobin (Hb) among patients with CD4 count <350 cell/mm3 was lower (7.90 g%) (standard deviation 1.48) compared to those having CD4 >350 cell/mm3 (P = 0.02). Children with severe immunological stage had a significantly lower mean Hb (adjusted estimate: −1.61, 95% confidence interval: −2.65, −0.56) compared to those who had normal immune status. No statistically significant differences in mean Hb at baseline when compared to various demographic and clinical characteristics were observed in unadjusted and adjusted regression models.Conclusion:Hb is an easy and inexpensive tool to measure and can be used for monitoring disease progression in a resource-limited setting.

Modus Operandi for Rehabilitating Aids with Tetrasilver Tetroxide Molecular Crystal Devices

AIDS is a set of symptoms or syndrome, cause by HIV. AIDS stands for ‘Acquired Immune Deficiency Syndrome’ and HIV ‘Human Immune Deficiency Virus’. This disease damages the immune system has great extent and makes the body prone to infections and diseases. The susceptibility of the body to diseases increases if the syndrome progresses. AIDS is also referred to as advance HIV infection or late stage of HIV. People with HIV may develop AIDS if not diagnosed until late or don't consistently take their antiretroviral therapy. The AIDS virus and AIDS symbiotic pathogens immunity suppressing moieties in humans is demolished by the use of the diamagnetic semiconducting molecular crystal tetra silver tetroxide Ag4O4. A single intravenous injection is required for the efficiency of the level 40 ppm of the human blood. The device accommodates 2 mono silver ions and 2 trivalent silver ions which is competent of firing and electrocuting the AIDS virus, pathogens and other ISM into the blood stream the electron triggered by a pathogen. When a proliferating virus and ISM fired continuously in a redox chelation mechanism then the resulting became a divalent silver moiety which binds to the active sites and destroy all of them. These devices are through innocuous and environmentally safe but yet, it may apply stress in liver which causes hepatomegaly, but keeps the liver function unaffected.

Тенденции и взаимообусловленность эпидемического процесса по ВИЧ-инфекции и туберкулезу на Северо-Западе России (аналитический обзор)

According to WHO, tuberculosis still remains the leading cause of death from infectious diseases in the world, ahead of HIV/ AIDS. The main causes of luck of the TB situation are the HIV pandemic and multidrug-resistant tuberculosis in all countries. The aim of the analytical review is to determine the trends and interdependence of the HIV and tuberculosis epidemic in North-West Region of Russia. The materials and methodological basis of the epidemiological analysis were the state statistical reporting forms on HIV-infection and tuberculosis from 2007-2017, some data - from 2000. Results. In the North-West Region of Russia, as well as in the whole country, the TB situation is improving. However, the main HIV indicators, in contrast to the federal data, have tended to decline during the recent years, especially in the Kaliningrad region, which came out of the number of territories with a high burden of HIV. However, there has been an increase in the number of patients with proficient HIV stages and in heterosexual route in the spread of human immunodeficiency virus. Conclusion. The HIV epidemic with an accumulation of patients with advanced HIV-stages and potentiated by the growth of the heterosexual route is the main factor in maintaining the tension of the TB situation in the North-West Region, as well as in the whole Russia, which requires strengthening measures to tackle HIV epidemic in the federal level.

When Men Touch Women Without License

<h3>Objectives</h3> Physician specialty is often positively associated with disease-specific outcomes and negatively associated with primary care outcomes for people with chronic conditions. People with HIV have increasing comorbidity arising from antiretroviral therapy (ART) related longevity, making HIV a useful condition to examine shared care models. We used a previously described, theoretically developed shared care framework to assess the impact of care delivery on the quality of care provided. <h3>Design</h3> Retrospective population-based observational study from 1 April 2009 to 31 March 2012. <h3>Participants</h3> 13 480 patients with HIV and receiving publicly funded healthcare in Ontario were assigned to one of five patterns of care. <h3>Outcome measures</h3> Cancer screening, ART prescribing and healthcare utilisation across models using adjusted multivariable hierarchical logistic regression analyses. <h3>Results</h3> Models in which patients had an assigned family physician had higher odds of cancer screening than those in exclusively specialist care (colorectal cancer screening, exclusively primary care adjusted OR (AOR)=3.12, 95% CI (1.90 to 5.13), family physician-dominant co-management AOR=3.39, 95% CI (1.94 to 5.93), specialist-dominant co-management AOR=2.01, 95% CI (1.23 to 3.26)). The odds of having one emergency department visit did not differ among models, although the odds of hospitalisation and HIV-specific hospitalisation were lower among patients who saw exclusively family physicians (AOR=0.23, 95% CI (0.14 to 0.35) and AOR=0.15, 95% CI (0.12 to 0.21)). The odds of antiretroviral prescriptions were lower among models in which patients’ HIV care was provided predominantly by family physicians (exclusively primary care AOR=0.15, 95% CI (0.12 to 0.21), family physician-dominant co-management AOR=0.45, 95% CI (0.32 to 0.64)). <h3>Conclusions</h3> How care is provided had a potentially important influence on the quality of care delivered. Our key limitation is potential confounding due to the absence of HIV stage measures.

Occurrence of hypocortisolism in HIV patients: Is the picture changing?

The occurrence of endocrine diseases in people who are infected with HIV is traditionally thought to occur in the setting of AIDS with opportunistic infections and malignancies. However, recent studies find the correlation between hypocortisolism and stage of HIV (CD4 count and WHO clinical stage) inconsistent. This descriptive cross-sectional study included three hundred and fifty (350) consecutive patients with HIV infection. They were interviewed, and subsequently underwent laboratory evaluation for the detection of hypocortisolism. Blood samples for serum cortisol estimation were taken at baseline and at 30 minutes following the administration of 1µg of tetracosactrin (Synacthen). In addition, the patients had blood samples taken at 0 minutes (baseline) for CD4+ lymphocyte cell counts. At baseline, 108 (30.9%) participants had serum cortisol levels below 100 µg/L with a median value of 55.48 µg/L (11.36-99.96 µg/L), but only 57 (16.3%) study participants had stimulated serum cortisol levels below 180 µg/L with median of 118 µg/L (19.43-179.62). There was no significant difference in the occurrence of clinical features between participants with low and normal serum cortisol, nor WHO clinical stage, CD4 count and ART regimen. The occurrence of hypocortisolism was higher among participants who had been on ART for a longer period of time. There is a high prevalence of hypocortisolism among HIV patients by biochemical testing, especially those who have been on ARVs for a longer duration. Hypocortisolism cannot be predicted based on the participants' WHO clinical stage of disease, CD4 cell count, or the treatment regimen. Personal Funds.

575. Older HIV-Infected Adults Are Twice More Likely to Present Late to Care

BackgroundThere are 36.7 million persons living with HIV globally and 1.1 million in the United States with additional ~45,000 new diagnosis annually. One in six newly diagnosed HIV-infected persons is older than 50 years of age. It is estimated that 45% of the US HIV population is over 50 years old and more than 10% are older than 60 years. HIV is more likely to be diagnosed at an advanced stage in older adults. Therefore there is a need to better understand the characteristics, staging of the disease, and response to treatment in older HIV-infected adults, in order to provide an effective treatment and prevention approach.MethodsA retrospective medical record review of all newly diagnosed HIV-infected patients was conducted at a single academic center HIV ambulatory clinic from January 1, 2010 to December 31, 2015. Patients demographics, age group, HIV staging, and response to antiretroviral treatment (ART) measured by HIV viral suppression at 12 weeks (HIV RNA <50 copies), and change in CD4 count were collected. Bivariate analysis was conducted comparing two groups of HIV-infected patients: younger group (age <50 years) and older group (age 50 years and older).ResultsFrom 2010 to 2015, 130 newly diagnosed HIV patients were enrolled in the clinic. Thirty-one (23.8%) were 50 years or older and of those 12 (38.7%) were 60 years and older. Older patients group were more likely to have AIDS defining illness at the time of diagnosis, compared with the younger group [19 (61.3%) vs. 29 (29.3%), respectively]. Of those eight (42%) were older than 60 years. Compared with the younger group, the majority of the HIV-infected patients in the older group who were on ART (61.5%) did not achieve HIV viral suppression at 12 weeks. However, both groups accomplished immune reconstitution with an increase in CD4 cell count in older and younger groups (mean CD4 count = 132 and 200 cell/dl, respectively). More than 80% of patients in both groups were on an integrase inhibitor ART-based regimen.ConclusionHIV-infected patients 50 years and older are more likely to present late to care, and to have a delay in HIV viral suppression compared with younger patient group. These findings are alarming and require emphasize on early HIV diagnosis. More data are required to understand the immune response to cART.Disclosures All authors: No reported disclosures.

SIV-Induced Immune Activation and Metabolic Alterations in the Dorsal Root Ganglia During Acute Infection.

Human immunodeficiency virus-associated sensory neuropathy (HIV-SN) remains a frequent neurologic complication of HIV infection. Little is known about alterations in the peripheral nervous system during the early stages of HIV, a time when neuroprotective interventions may be most beneficial. We performed Nanostring gene expression analysis on lumbar dorsal root ganglia (DRG) from 6 simian immunodeficiency virus (SIV)-infected pigtailed macaques killed at 7 days post-inoculation and 8 uninfected controls. We found significant upregulation of many genes involved in immune signaling and activation in the DRG. Among genes related to glutamate metabolism, there was significant upregulation of glutamine synthetase (GS), while glutaminase (GLS) was downregulated. Several genes involved in the oxidative stress response also showed significant differential regulation in the DRG of 7d SIV-infected animals, with superoxide dismutase-2 (SOD2) showing the greatest median fold change compared to controls. Novel findings in the DRG were compared to corresponding brain data and further investigated at the protein level by Western blotting and immunohistochemistry. Together with our previous finding of significant epidermal nerve fiber loss at 14 days post-SIV infection, results of this study demonstrate that immune activation and altered cellular metabolism at in the DRG precede and likely contribute to early sensory nerve injury in HIV-SN.

English

The elimination of HIV-AIDS by 2030 is a challenging target for a country such as the D.R. Congo, since currently fewer than 50% of persons living with HIV (PLWH) are under antiretroviral treatment (ART) and have a viral suppression. There also a high rate of death of PLWH in D.R. Congo. Accessible, affordable and sustainable immunotherapy, coupled with ART, can provide a substantial support to eliminating HIV. The purpose of this paper is to describe the measured clinical and biological profiles over a 4-year period of treatment with the immunomodulator 6,6&rsquo;-dithiodinicotinic acid (CPDS), of a patient who was only 10-months old at the start of treatment. The patient was part of a larger two-year clinical trial of CPDS on HIV-AIDS. This study found that despite his advanced clinical HIV stage (being born to parents with terminal HIV), the patient maintained his weight and lymphocyte counts, and did not experienced any severe HIV-AIDS-related illness during the study period. This suggests a beneficial or protective effect of CPDS treatment. The patient shifted to ARV at 5-years old and is now 17-years old, and under first-line ART. The study concludes that survival of this child could likely be attributed to CPDS. We therefore recommend exploring further the simultaneous use of ART and CPDS immunotherapy for a greater clinical and biological benefit of PLWH.&nbsp; We also recommend further study into the mechanism of action of the compound. Key words: HIV-AIDS treatment, immunomodulation, 6,6&rsquo;-dithiodinicotinic acid.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp

Distinguishing Brain Impact of Aging and HIV Severity in Chronic HIV Using Multiparametric MR Imaging and MR Spectroscopy.

BackgroundCombination antiretroviral therapy (cART) has transformed HIV into a manageable but complex chronic disease, in which it is uncertain which brain insults may relate to age vs initial disease severity. We evaluate N-acetyl-aspartate/creatine (NAA/Cr), white matter hyperintensities (WMH), and mean cortical thickness to identify which subclinical markers of brain insult best relate to CD4 nadir and aging. This is a prospective study of the association between brain markers with age and initial infection severity, based on CD4 nadir, in chronic HIV patients.MethodsThirty-seven chronic HIV patients (age 25–77 years) with successful viral suppression were scanned on a GE 3T magnetic resonance imaging scanner to obtain NAA/Cr (standardized and averaged over 5 brain regions), log-transformed WMH volume, and mean cortical thickness. The brain measures were fitted with both CD4 nadir and age to evaluate the significance of their relationship.ResultsNAA/Cr, WMH, and cortical thickness were all correlated with age and CD4 nadir in unadjusted associations. Stepwise regression models showed that NAA/Cr alone best predicted CD4 nadir (β = 40.1 ± 13.3; P = .005), whereas WMH (β = 2.3 ± .9; P = .02) and mean cortical thickness (β = –2.7 ± 6.6; P < .0001) together produced the best model fit with age. NAA/Cr was higher for HIV stage 1 (CD4 nadir ≥ 500 cells/ µL; n = 15) compared with stage 2 (200 ≥ CD4 nadir < 500; n = 13) and stage 3 (CD4 nadir < 200; n = 9; P < .01 for both).ConclusionsIn patients with effectively suppressed HIV, NAA reflects the subclinical brain impact of initial disease severity related to development of even mild immune compromise, whereas cortical thickness and WMH volume are useful to evaluate age-related changes.

Age and HIV stage at initiation of highly active antiretroviral therapy determine non-reversal of stunting at 3 years of treatment

Background Highly active antiretroviral therapy (HAART) has been reported to improve growth, especially in the first 2 years of treatment. It is not clear whether catch up growth is maintained after 2 years of HAART.&#x0D; Objective To assess growth in stunted children with HIV after 3 years of HAART and analyze possible risk factors for non-reversal of stunting.&#x0D; Methods This study was done from May 2016 to April 2017 to follow children with HIV who started HAART between January 2009 and April 2014, and continued for 3 years. Inclusion criteria were children with HIV, aged &lt; 18 years, compliance to the regimen, and stunting. Exclusion criteria were patients lost to follow up or who died prior to 3 years of HAART. Non-reversal of stunting was defined as HAZ ≤ -2SD after 3 years of HAART. Possible risk factors for non-reversal were analyzed using Chi-square test with P&lt;0.05, as well as risk ratio (RR) and 95% confidence intervals (CI).&#x0D; Results Of 150 HIV-infected pediatric patients, 115 were on HAART and 55 (47.8%) were stunted at HAART initiation. Of the 55 stunted and HAART-treated children, 31 (56.4%) were male. Baseline median age was 3.6 years (interquartile range 0.37-8.48). Non-reversal occurred in 32 (58.2%) subjects. Multivariate Cox regression model analysis showed predictors of non-reversal after 3 years of HAART to be age &gt;2 years (RR 16.05; 95%CI 2.89 to 89.02; P=0.002) and HIV stage III-IV (RR 8.93; 95%CI 1.47 to 54.37; P=0.017).&#x0D; Conclusion HAART initiation at age &gt;2 years and HIV clinical stage III-IV at diagnosis are risk factors for non-reversal of stunting after 3 years of HAART.