Human Immune Deficiency Virus Infection Research Articles

Varicella-associated disseminated intravascular coagulation secondary to Henoch-Schönlein purpura with renal and gastrointestinal system involvement in a child: A case report.

Immunocompromised patients who developed varicella-zoster virus (VZV)-associated disseminated intravascular coagulation (DIC) previously included recipients of bone marrow, hematopoietic stem cell, or organ transplantations, patients with primary nephropathy receiving corticosteroid therapy, cancer patients receiving chemotherapy, and patients with human immune deficiency virus infection. The case reported here is novel because, to our knowledge, there has been no report of VZV-associated DIC after the onset of Henoch-Schönlein purpura (HSP). To report the successful treatment of a novel pediatric case with VZV-associated DIC secondary to HSP. An 8-year-old girl developed VZV-associated DIC 24 days after diagnosis of HSP with renal and gastrointestinal involvement. She was treated with methylprednisolone at a local hospital for 19 days, and suddenly developed fever starting from day 4 in our hospital. Her fever persisted with vesicular skin rashes on her back, strong abdominal and lower back pain, epistaxis, hematochezia, erosion and bleeding on her lips, in her mouth and at puncture sites on day 5. She was diagnosed with DIC with the laboratory evidence of dramatically decreased platelet count and fibrinogen, prolonged activated partial thromboplastin time and prothrombin time, and increased fibrin degradation products including d-dimers. She also developed multiple organ dysfunction syndrome. On day 7, the patient VZV nucleic acid result turned out to be positive. Methylprednisolone treatment was discontinued, and she was given a multi-modality therapy including medications of acyclovir and antibiotics, intravenous gamma-immunoglobulin, various blood product transfusions, continuous renal replacement therapy, plasma exchange, and administration of liver and gastrointestinal system protection drugs. The patient multi-organ function damage gradually recovered. After VZV control, the patient was treated with oral methylprednisolone again for HSP with nephritis. Urine analysis was normal 1 year later, and oral hormone was discontinued. No complication or relapse occurred during 2 years of follow-up. This case report, for the first time, adds HSP treated with corticosteroids to the spectrum of clinical conditions that progressed to life-threatening secondary varicella-associated DIC. Early identification of varicella infection and DIC, combined with timely antiviral, immunoglobulin transfusion, plasma exchange, and other combined therapies are essential for saving patients' lives.

Assessments of viral load and haematological parameters in HIV patients on HAART in Ilorin, Kwara state

Human immune deficiency virus (HIV) infection represents the most common cause of acquired immune deficiency and leads to clinical disease referred to as Acquired Immune Deficiency Syndrome (AIDS). Highly active antiretroviral therapies (HAART) are the gold standard for the management of HIV disease. Viral load indicates that treatment is effective. A high viral load in a person on treatment indicates either that the medication is not being taken properly or that the virus is becoming resistant to the medication. This is a comparative study aimed at assessing the Viral load count and haematological parameters. 120 HIV positive individual and 40 HIV negative subjects were recruited for this study,while haematological parameters were carried out using Sysmex KX-21 analyser. Results was analyzed using SPSS version 20. .Our result shows the following mean absolute counts of haematological parameters; lymphocyte count of HIV positive persons to be 1.42±1.82, Neutrophil 1.64±2.80, Monocyte 0.07±0.08, Basophil 0.05±0.06 Eosinophil 1.71±3.42 while the mean value of TWBC 5.130±1.43, RBC 3.97±0.48, HB 11.41±1.65, MCV 87.054±15.59 and MCHC MCHCf/l, compared to 0.78±0.08, 1.10±0.32, 0.06±0.02, 0.01±0.01 and 1.14±3.42 respectively among the HIV negative individual. In conclusion, we found that the use of antiretroviral drugs could positively or negatively affect haematological parameters, depending on the choice of combination used.

Perceptions of HIV Positive Mothers on Feeding Options for their Potentially HIV Infection-Exposed Infants at Beitbridge Hospital, Zimbabwe

Infant feeding directly affects the nutritional status of children under 2-years of age and, ultimately, impact child survival. Human Immune Deficiency Virus (HIV) infection brings even more challenges to the feeding practices of HIV positive mothers due to adjustments with the aim of preventing mother-to-child HIV transmission. The perceptions of HIV positive mothers on the feeding options adopted for their exposed infants at Beitbridge District Hospital, Zimbabwe, was explored. A qualitative approach was utilized for the study using purposive sampling to select a sample of 11 mothers on whom in-depth structured interviews were conducted. Knowledge gaps pertaining to the recommended feeding options with most of them not adhering to the ideal feeding options existed amongst HIV naïve mother. Some practiced exclusive breastfeeding, others used mixed feeding. Constraints included culture which has a strong impact on feeding options and lack of partner and family support, coupled with low HIV status disclosure levels. Ways of improving adherence to ideal feeding options were suggested as educating and counselling HIV positive mothers on feeding options and follow-ups to enhance ideal feeding practices. Recommendations were to capacitate the midwives with the requisite information to facilitate education and empowerment of the mothers for informed infant feeding choices through review of curriculum. Review of strategies for enforcing a breastfeeding environment was also recommended. There is also need to address cultural, autonomy and stigma challenges through scaling up psycho-social and gender empowerment strategies for women. Promotion of the integration of HIV infant feeding strategies into other child health services is essential.

A microfluidics chemiluminescence immunosensor based on orientation of antibody for HIV-1 p24 antigen detection

The HIV-1 capsid protein, p24 antigen, is a recognizable early diagnostic biomarker for human immune deficiency virus (HIV) infection. However, the existing methods address the limitations of high cost, cumbersome operations, long analysis time, and insufficient sensitivity and selectivity. Herein, an antibody oriented microfluidic chemiluminescence biosensor based on multiple signal amplification strategy was developed for rapid and ultrasensitive detection of HIV-1 p24 antigen. The microfluidic device contained an upstream snake-shape mixing channel and a downstream ship-shape microcavity with micropillar arrays for sufficient mixing of CL reagents, efficient capture of p24 antigen, double antibody sandwich reaction, hybridization chain reaction (HCR) amplification and CL detection. The multiple signal amplification was realized by antibody orientation, multiple HCRs on antibody and initiator chain modified gold nanoparticles (Ab2-AuNPs-I), and HRP and AuNPs synergistic catalyzed CL reaction. Using the platform, the detection of target p24 is converted to the detection of nucleic acid with a limit detection of 0.212 pg mL−1 and excellent specificity within 2 h of total analysis time, which is better or comparable to previously reported biosensors. Moreover, the biosensor exhibited an excellent recovery rate ranging from 92.7% to 102.3%. Therefore, the proposed method holds great potential in clinical diagnosis.

A Review on Inflammasomes and Immune Checkpoints in Pre-Eclampsia Complicated with Tuberculosis and Human Immune Deficiency Virus.

The current review evaluates how inflammasomes and immune checkpoints are regulated in pre-eclampsia (PE) associated with tuberculosis (TB) and Human Immune Deficiency Virus (HIV). Studies indicate that inflammasomes such as (NRLP3, NEK7, and AIM2) and immune checkpoints such as (CLT4, PD-1, TIM3, and LAG-3) are dysregulated in TB- and HIV-infected individuals, and also in pre-eclamptic pregnancies, which explains why pregnant women who are either infected with TB or HIV have an increased risk of developing PE. Evidence suggests that inhibition of inflammasomes and immune checkpoints may assist in the development of novel anti-inflammatory drugs for the prevention and management of PE in patients with or without TB and HIV infection.

Women's voices: the lived experience of HIV-positive women in the postpartum period at the University of Gondar comprehensive specialized referral hospital, Ethiopia: a phenomenological study

BackgroundPregnancy and the postpartum period are incredibly challenging for women living with the Human Immune Deficiency Virus (HIV) due to the multidimensional influence of HIV infection. These women experience the challenges of navigating pregnancy and motherhood while living with HIV. It is poorly understood how women living with HIV (WLWH) experience pregnancy and postpartum. Therefore, the current study aimed to explore the lived experience of pregnancy and postpartum among women living with HIV.MethodsA phenomenological qualitative study design was employed. A semi-structured, interview guide was used to conduct in-depth interviews with HIV-positive postpartum women from April to May 2022. All interviews were recorded using a voice recorder and note was taken. The collected data were transcribed and translated into English for analysis. Inductive thematic analysis was applied to analyze the data.ResultsSix main themes about the lived experience of women living with HIV were identified: (1) Fear and distress related to maternal and child Health, (2) HIV status self-disclosure dilemma, (3) Courage and commitment of HIV-positive women to prevent HIV, (4) Challenges faced and coping mechanisms used by HIV-positive women, (5) Health care providers and HIV-positive women interaction, and (6) Solution from their voices.ConclusionHIV infection also has a multidimensional impact on women’s life during pregnancy and postpartum. The findings of this study improve our understanding of the lived experience of HIV-positive women while pregnant and in the postpartum period. These women's descriptions showed that they have been experiencing various challenges that are not often addressed in antenatal clinics, such as distress and uncertainties related to vertical transmission of HIV. These women need specialized support and all-encompassing care to have a healthy pregnancy and postpartum period. Moreover, it is essential to understand the circumstances of women's lives, their relationships with others, and their decision-making processes. Healthcare professionals and other responsible bodies working with women living with HIV should encourage and support these mothers to appraise and maintain their commitment to protecting their children from acquiring HIV infection and maintaining their Health to the maximum to raise their children.

HIV and its associated factors among people who inject drugs in Mizoram, Northeast India.

To estimate the prevalence and associated factors with the human immune-deficiency virus (HIV) among people who inject drugs (PWID) in Mizoram, Northeast India. The data source for the analysis was the 2019-2020 Mizoram State AIDS Control Society (MSACS) survey from 2695 PWID registered for the Targeted Intervention (TI) services. Logistic regression analysis was conducted to examine the factors associated with HIV among PWID after adjusting for sociodemographic characteristics, injection, and sexual behaviours. 21.19% of the participants tested positive for HIV and the prevalence of HIV among male and female participants were 19.5% and 38.6%, respectively. Multiple logistic regression analysis revealed that female (AOR 1.74; 95% CI 1.26-2.41), 35 years or older (AOR 1.45; 95% CI 1.06-1.99), married (AOR 1.41; 95% CI1.08-1.83), divorced/separated/widowed (AOR 2.12; 95% CI 1.59-2.82) and sharing of needle/syringe (AOR 1.62; 95% CI 1.30-2.00) were all positively associated with HIV infection. We also found that concomitant alcohol use was reduced by 35% (AOR 0.65; 95% CI 0.51-0.82) among HIV positive PWID, and HIV infection was also reduced by 46% (AOR 0.54; 95% CI 0.44-0.67) among those PWID who use a condom with a regular partner. The findings of this study suggested that there is a high prevalence of HIV among PWID with 1 in 5 PWID reported to have HIV. HIV among PWID was significantly higher among those over 35 years of age, females and divorced/separated/widowed participants. Needle/syringe sharing behaviour is an important determinant of HIV infection. The high prevalence of HIV among PWID population is multifactorial. To reduce HIV among PWID in Mizoram, interventions should target those sharing needles/syringes, females, especially those over 35 years of age and unmarried participants.

Effect of Sickle Cell Trait on the Treatment Response of Individuals Infected with Human Immune-Deficiency Virus (HIV)

Background: Sickle cell disease is of public health importance and comes with systemic organ complications that can cause long-term disabilities and early death.
 Aim: This study was to determine the effect of co-existence between sickle cell gene (HbS) and HIV infection in a Lagos population.
 Methods: The study was conducted at the anti-retroviral (ARV) outpatient clinic of the Nigerian Institute of Medical Research (NIMR), Yaba, Lagos. It is a cross-sectional cohort study of 292 adult HIV- positive patients who were enrolled for treatment and support in the centre between the year 2004-2015. A review of case notes and database was done to extract haematologic, immunologic, virologic and clinical information of the patients. The enrolled participants were invited for additional clinical and socio-demographic information using a structured questionnaire. Blood samples were collected and reanalysed to confirm the haemoglobin genotype. Data analysis was performed using SPSS software.
 Results: Out of 292 recruited patients, 274 participants had complete data of which 74.1%, 22.9% and 2.9% were HbAA, HbAS and HbAC respectively. Sickle cell trait (SCT) was found in 25.9% of the participants and there was no record of sickle cell disease (SCD). HbAA participants were found to have a higher viral load (87.5%) at baseline (P < 0.001). For HbAA and SCT groups, treatment response over the years was similar with lower figures seen in SCT.
 Conclusion: It was concluded that lower HIV viraemia in SCT might mean a delay in HIV-1 disease progression and subsequently better quality of life for such patients.

Demographic Factors Among HIV Confirmed Blood Donors from 2013 to 2021 in Shenzhen.

New HIV (Human immune deficiency virus) infections are continuously increasing in China and it remains a huge challenge to blood donation.As access to health services has affected by COVID-19 (Corona virus disease 2019) pandemic, a drop in new diagnoses (especially HIV) was observed worldwide. During 2013-2021, 735,247 specimens from unpaid blood donors collected by Shenzhen Blood Center underwent ELISA (Enzyme -linked immunosorbent assay) and NAT (Nucleic acid test). Samples with reactivity results were sent to the Shenzhen Center for Disease Control and Prevention for WB (Western blot). All data were statistically analyzed by the Chi-Square test. From 2013 to 2021, the prevalence of HIV among male blood donors was higher than in females (P < 0.01). During the COVID-19 pandemic, the prevalence of HIV among repeat blood donors decreased significantly compared to 2019 (P < 0.05), and the characteristics of blood donors changed in 2020 compared to 2019 and 2021. The high proportion of female blood donors would help prevent HIV from getting into the blood supply. The COVID-19 pandemic affected the demographics of blood donors as well as the prevalence of HIV among repeat blood donors. An increased number of repeat blood donors can help decrease the risk of HIV transfusion transmission during the epidemic.

Non-dengue related febrile thrombocytopenia in HIV patient: a case report

In tropical areas, febrile thrombocytopenia is often caused by infectious diseases, especially dengue. Thrombocytopenia is common in Human Immunedeficiency Virus (HIV) patients at any stage or as a complication of the illness. Here we presented a case report of a 38-year-old female initially diagnosed with dengue fever but turn out to be thrombocytopenia due to HIV infection with pneumocystis carini pneumonia (PCP). Febrile thrombocytopenia in people living with HIV should be observed carefully. It may be caused by a new opportunistic infection or as the natural progression of HIV disease.

Frequency of Human Immune Deficiency Virus (HIV) Infections at Tertiary Care Hospital of Karachi from 2017-2019

Frequency of Human Immune Deficiency Virus (HIV) Infections at Tertiary Care Hospital of Karachi from 2017-2019

Recruitment of the CoREST transcription repressor complexes by Nerve Growth factor IB-like receptor (Nurr1/NR4A2) mediates silencing of HIV in microglial cells.

Human immune deficiency virus (HIV) infection in the brain leads to chronic neuroinflammation due to the production of pro-inflammatory cytokines, which in turn promotes HIV transcription in infected microglial cells. However, powerful counteracting silencing mechanisms in microglial cells result in the rapid shutdown of HIV expression after viral reactivation to limit neuronal damage. Here we investigated whether the Nerve Growth Factor IB-like nuclear receptor Nurr1 (NR4A2), which is a repressor of inflammation in the brain, acts directly to restrict HIV expression. HIV silencing following activation by TNF-α, or a variety of toll-like receptor (TLR) agonists, in both immortalized human microglial cells (hμglia) and induced pluripotent stem cells (iPSC)-derived human microglial cells (iMG) was enhanced by Nurr1 agonists. Similarly, overexpression of Nurr1 led to viral suppression, while conversely, knock down (KD) of endogenous Nurr1 blocked HIV silencing. The effect of Nurr1 on HIV silencing is direct: Nurr1 binds directly to the specific consensus binding sites in the U3 region of the HIV LTR and mutation of the Nurr1 DNA binding domain blocked its ability to suppress HIV-1 transcription. Chromatin immunoprecipitation (ChIP) assays also showed that after Nurr1 binding to the LTR, the CoREST/HDAC1/G9a/EZH2 transcription repressor complex is recruited to the HIV provirus. Finally, transcriptomic studies demonstrated that in addition to repressing HIV transcription, Nurr1 also downregulated numerous cellular genes involved in inflammation, cell cycle, and metabolism, further promoting HIV latency and microglial homoeostasis. Nurr1 therefore plays a pivotal role in modulating the cycles of proviral reactivation by potentiating the subsequent proviral transcriptional shutdown. These data highlight the therapeutic potential of Nurr1 agonists for inducing HIV silencing and microglial homeostasis and ultimately for the amelioration of the neuroinflammation associated with HIV-associated neurocognitive disorders (HAND).

The effect of protease inhibitors-based antiretroviral therapy on serum/plasma interleukin-6 levels among PLHIV: a systematic review and meta-analysis.

Recommended treatment regimen for human immune deficiency virus (HIV) infection includes protease inhibitors/ritonavir (PIs/r) combined with two-nucleoside reverse-transcriptase inhibitors (2NRTIs), which enable to achieve and maintain viral suppression, restore, and preserve immune function. However, there were inconsistent findings on the levels of interleukin-6 (IL-6) levels. Systematic review and meta-analysis were performed to quantify the pooled effects of PIs/r-based antiretroviral therapy (ART) on serum/plasma IL-6 levels in people living with the HIV (PLHIV). PubMed, Web of Science, and Embase were searched from the earliest record to November 4, 2020. Data analysis was conducted on Stata version 16 and Review Manager 5.3. A random-effect model was used to compute a pooled effect size and weighted mean difference (WMD) was considered the summary effect size. Heterogeneity between studies was estimated by Cochrane's Q test (χ2 test) and I2 statistic and subgroup analysis were performed to explore the source of heterogeneity. Initial search identified 3098 records and 5 studies (7 trials) met inclusion criteria. The pooled mean difference in serum/plasma IL-6 levels from baseline to follow-up was 0.534 pg/ml (95% confidence interval: -0.012, 1.08, P = 0.05, I2 = 76.4%). In subgroup analysis, there was a significant association between increased serum/plasma IL-6 levels and age group ≥ 35 years old, baseline CD4+ counts < 350 cell/mm3 , and mean viral load ≥ 4.5 log10 copies/ml. We found that serum/plasma IL-6 levels increased after combined ART among treatment-naïve individuals who initiated a successful combination of PIs/r with 2NRTIs. This result also highlights the need to monitor serum/plasma IL-6 levels during antiviral therapy, which may aid in the effective future treatment of systemic inflammation and related disorders following elevated IL-6 levels.

Prevalence and associated factors of HIV testing among young (15\u201324) women in eastern Africa: a multilevel analysis of demographic health survey data (2008-2018)

BackgroundAccording to available evidence, only 15% of young women in sub-Saharan Africa know their Human immune deficiency virus (HIV) status. Despite a high prevalence of HIV infection among adolescents and young women, policymakers give less attention to HIV testing and counseling services. So, this study aimed to investigate the pooled prevalence and associated factors of HIV testing among young women in east Africa.MethodsThe most recent DHS surveys done among 11 east African countries were pooled and a weighted sample of 73,661 young women were included. At bivariable analysis variables with a p-value≤0.2 were selected for multivariable analysis and variables with a p-value of ≤0.05 in the multivariable analysis were considered as a statistically significant determinant of HIV testing.ResultsPooled prevalence of HIV testing among young women was 55.3%: 95% CI (54.97%, 55.69%). In the multilevel multivariable analysis: respondent age, marital status, educational level, occupation, media exposure, having higher and comprehensive knowledge about HIV / AIDS, having some and higher risky sexual behavior, visiting health care facilities, being rural dweller, being from rich households, having multiple sexual partners, early sex initiation and community-level education were significantly associated with HIV testing.ConclusionThe prevalence of HIV testing among young women was significantly affected by both individual and community-level factors. To prevent the transmission and dissemination of HIV, there should be a systematic and coordinated approach and policy for HIV testing among young people.

Spatial-temporal analysis of HIV/AIDS and syphilis in mainland China from 2007 to 2017.

Human immune deficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and syphilis are the most common sexually transmitted diseases (STDs) worldwide, as well as in China. The objective of this study is to describe the trend of spatial and temporal variation of HIV/AIDS and syphilis in mainland China from 2007 to 2017. Stratified analysis was conducted according to age and the GDP per capita. Estimated Annual Percentage Change (EAPC) was calculated and spatial autocorrelation analysis was used to evaluate the epidemiology and identify clusters. The morbidity of new HIV infection increased from 2.5034/100 000 in 2007 to 6.9247/100 000 in 2017, with an EAPC of 9.84 (95% confidence interval [CI]: 9.07-10.60). From 2007 to 2017, the morbidity of syphilis presented a significant upward trend from 15.8834/100 000 to 34.4867/100 000 (EAPC = 6.48, 95% CI: 4.23-8.73). The number of new HIV infections (205 084) and syphilis (921 279) were highest in the 20-30 years old group, where the incidence decreased with age over 20 years. In general, HIV and syphilis infection had the same incidence trend according to age and time stratification. The morbidity of new HIV infection was mainly reported from Xinjiang and southwestern China. As for syphilis, the highest was found in Zhejiang in Xinjiang and southeast coastal areas. Both HIV and syphilis infection showed a nonrandom positive correlation by Moran's I value. The High-High cluster areas of HIV infection were concentrated in southwestern and eastern China due to syphilis. A highly significant positive correlation was found between gross domestic product per capita and syphilis infection (p < 0.05) but was not associated with HIV infection. The incidence of AIDS/HIV and syphilis is increasing year by year, and a higher prevalence is found in younger individuals. More attention should be paid to HIV infection in the southwest, syphilis in southeast coastal areas, and both the two diseases in Xinjiang.

Co-occurrence of toxic epidermal necrolysis in a human immune deficiency virus infected person due to elthrombopag or ofloxacin – a rare occurrence

Toxic epidermal necrolysis (TEN), a severe drug reaction which is more commonly seen in human immune deficiency virus (HIV) infected persons. It occurs commonly with anti-retroviral treatment and sulfonamides. TEN is reported previously with ofloxacin. But there are no reported cases of elthrombopag induced TEN. Early identification and withdrawal of the culprit will enhance rapid recovery and less mortality. Reporting the noted medications vulnerable for TEN will help medical personal in identifying the drug reaction and causative.&#x0D; We are reporting a 45 years old male with HIV infection developed TEN with elthrombopag and ofloxacin. We identified skin tenderness of erythematous maculopapular lesions as an early identification feature for TEN before appearing typical mucosal lesions, dusky red necrotic skin patches or nikolsky sign.

Curcumin prevents tenofovir/lamivudine/efavirenzinduced nephrotoxicity in rats

Background and Aims: Nephrotoxicity is an adverse effect, which may occur with the use of tenofovir/lamivudine/efavirenz (TLE) in the treatment of human immune deficiency virus (HIV) infection. Curcumin (CUM), an isolate of Curcuma longa L. is used in folk medicine for the treatment of ailments. This study attempts to establish whether CUM supplementation can protect against a rat model of TLE-induced nephrotoxicity. Materials and Methods: Adult male Wistar rats (n=40) were randomly grouped and supplemented orally with CUM (50, 100 and 200 mg/kg/day) prior to the oral administration of TLE (300/300/600 mg/kg/day) for 30 days. After the treatment, the rats were fasted overnight, weighed and anesthetized. Blood samples were collected, and sera were extracted for biochemical analyses. Kidney samples were excised, weighed and processed for oxidative stress markers and histology. Results: Body weight was decreased (p&lt;0.01) whereas kidney weight was increased (p&lt;0.01) in TLE administered rats when compared to the control. Significant (p&lt;0.001) increments in serum uric acid, creatinine, urea and kidney malondialdehyde levels were observed in TLE-administered rats. Significant (p&lt;0.001) decreases in serum total protein, albumin, electrolytes, kidney superoxide dismutase, glutathione, catalase and glutathione peroxidase levels were observed in TLE administered rats when compared to the control. TLE produced tubular necrosis and hypercellular glomerulus with mesangial proliferation in the kidneys of treated rats. However, CUM (50, 100 and 200 mg/kg) supplementation abrogates TLE-induced nephrotoxicity in a dose-related manner at p&lt;0.05, p&lt;0.01 and p&lt;0.001, respectively, when compared to TLE group. Conclusion: CUM seems effective against TLE-induced nephrotoxicity.

10.2174/0250688202666210402094638

Background: Lactic acidosis of any etiology is associated with poor prognosis and often fatal. The survival in lactic acidosis depends on the ability to identify and remove the cause and managing organ perfusion. Nucleoside Reverse Transcriptase Inhibitors (NRTIs), which are used widely in the treatment of Human Immune Deficiency Virus (HIV) infection, are known to cause life-threatening Type B lactic acidosis. Case Presentation: Severe lactic acidosis can cause organ failure, especially in respiratory and cardiovascular systems. However, the role of acute lactic acidosis in these organ failures is mostly suggested by experimental studies in animals or in vitro, as few clinical studies in humans are available. Acidosis elevates pulmonary vascular resistance, giving rise to pulmonary hypertension and peripheral vasodilation with an associated fall in blood pressure and systemic hypotension. Although lactic acidosis presenting as abdominal pain, vomiting, and pancreatitis have been reported in persons receiving antiretroviral therapy, the presentation as acute right heart failure has rarely been documented in the literature. We report a case of severe metabolic and lactic acidosis in a patient receiving stavudine and lamivudine, with a rare and atypical presentation as acute right heart failure and severe pulmonary hypertension. Conclusion: This case emphasizes the need to consider lactic acidosis as a potential cause in patients presenting with acute unexplained right heart failure and severe pulmonary hypertension.

Prevalence and predictors of Kaposi’s sarcoma among HIV patients receiving care at a tertiary hospital in Jos, Nigeria

Background Kaposi’s sarcoma became prevalent with the appearance of human immune deficiency virus (HIV) in the 1980s. However, the widespread use of the highly active antiretroviral therapy (HAART) reduced its prevalence in communities with good access to the antiretroviral drugs. The objective of this study was to determine the prevalence and predictors of Kaposi’s sarcoma among persons receiving HIV care at a tertiary hospital in Jos, Nigeria. Methods The study used a cross-sectional study design, based on secondary data related to patients who had received HIV care between January 2004 and December 2017. Logistic regression was then used to determine the variables that were predictors of Kaposi’s sarcoma risk. Results The prevalence of Kaposi’s sarcoma among the patients was 1.2% (95% confidence interval, CI=1.06-1.34). Patients whose baseline viral loads were higher than 10,000 copies/mm3 were three times more likely to develop Kaposi’s sarcoma than those with lesser viral load (OR: 3.13, CI: 2.19-4.47). Gender, duration of HAART and education had modifying effect on the Kaposi’s sarcoma risk. Conclusions Kaposi’s sarcoma is a substantial public health problem among the HIV population in Jos. Universal access to HAART by the Federal Government of Nigeria and its partners is recommended to reduce its prevalence. In addition, education, skill acquisition and income generating programs should be targeted at girls and women by governments and other stakeholders in order to reduce the inequality that worsens their vulnerability to HIV infection and Kaposi’s sarcoma.

Prevalence of Leucopenia and Associated Factors before and after Initiation of ART among HIV-Infected Patients, North East Ethiopia: Cross-Sectional Study.

BackgroundLeucopenia is the commonest hematological abnormaly that occurs in patients with human immune deficiency virus (HIV) infection. The magnitude and related factors of leucopenia during the time of ART are not characterized in Ethiopia. This study aimed to assess the prevalence of leucopenia before and after the initiation of ART among HIV patients attending Debre Berhan Referral Hospital (DBRH), North East Ethiopia.MethodsA cross-sectional study was conducted from September to December 2020 in DBRH, North-East Ethiopia. A total of 272 patients on ART were selected by simple random sampling techniques. Socio-demographic and clinical characteristics of the study participants were collected by standard questionnaires. Measurements of leucocyte count and CD4 counts were made by Sysmex XT 2000i hematology analyzer and BD FACS count CD4 analyzer, respectively. Statistical analysis of data was done by SPSS version 23. Logistic regression was done and a P-value<0.05 was taken as statistically significant.ResultsThe prevalence of leucopenia, neutropenia, and lymphopenia were 20.9%, 7.0%, and 6.6% before initiation of ART and 15.4%, 1.1, and 4.4% after initiation of ART, respectively. There was a significant difference in total white blood cell count, absolute neutrophil count, and total lymphocyte count between patients on ART and ART naïve patients. HIV patients whose cluster of differentiation (CD4) counts were <200 cells/µL and patients on a zidovudine (AZT)-based regimen were more likely to have leucopenia than HIV patients whose CD4 counts were ≥ 200 cells/µL and on a tenofovir (TDF)-based regimen.ConclusionIn this study, the prevalence of leucopenia, neutropenia, and lymphopenia has shown a significant decrement after the initiation of ART. HIV patients with low CD4 count and on an AZT-based regimen are more likely to have leucopenia, neutropenia, and lymphopenia. Based on our findings, we recommend that the health care professional routinely investigate and should treat leucopenia.