Human Immunodeficiency Virus Infected Individuals Research Articles

Diabetes mellitus and risk factors in human immunodeficiency virus-infected individuals at Jimma University Specialized Hospital, Southwest Ethiopia.

BackgroundGlobally, diabetes is rising dramatically causing high health burden in low- and middle-income countries. It is estimated that about 382 million people had diabetes in 2013. In 2013, diabetes caused 5.1 million deaths globally. Almost 80% of diabetes deaths occur in low- and middle-income countries.PurposeTo assess the magnitude of diabetes mellitus (DM) and associated risk factors in human immunodeficiency virus (HIV)-infected individuals.MethodsAn institution-based cross-sectional study was conducted from April to May 2014 at Jimma University Specialized Hospital. Convenient sampling technique was implemented. Sociodemographic and anthropometric data were collected by senior clinical nurses. Venous blood was collected from each study participant. Serum glucose and lipid profile of the study participants was measured using HumaStar 80 spectrophotometer. Data were analyzed using SPSS version 20. Bivariate and multivariate logistic regressions were utilized.ResultsA total of 393 HIV-infected individuals of age ranging from 21 years to 75 years had enrolled in this study. The overall prevalence of DM in this study was 6.4% (n=25). Two hundred and ninety-one (74%) and 77 (19.6%) of the study participants had normal (70–110 mg/dL) and impaired (111–125 mg/dL) fasting blood glucose values, respectively. After adjusting for the other variables, age (adjusted odds ratio [AOR] =4.812, 95% confidence interval [CI]: 1.668–13.881, P=0.004), duration of highly active antiretroviral therapy (HAART) (AOR =26.928, 95% CI: 3.722–194.822, P=0.001), hypertension (AOR =4.779, 95% CI: 1.646–13.874, P=0.004), and low-density lipoprotein cholesterol (AOR =5.669, 95% CI: 1.849–17.382, P=0.004) were significantly associated with DM.ConclusionHAART may have an impact on the cause of diabetes. Hence, HIV-infected individuals should be screened for diabetes, both before and after initiation of HAART.

Assessment of the Prevalence of HIV Infection at Four Health Facilities in Dilla Town, Ethiopia

Citation: Alemu F (2015) Assessment of the Prevalence of Hiv Infection at Four Health Facilities in Dilla Town, Ethiopia. J Aids Hiv Infec 1(1): 101. doi: 10.15744/2454-499X.1.101 Volume 1 | Issue 1 Journal of AIDS and HIV Infections Introduction The successful introduction and spread of the human immunodeficiency virus (HIV) into the global human population may have first emerged among humans in the early part of the 20th century (most likely contracted from infected primates). However its spread among vulnerables populations may have occurred in the 1970s. In Europe and North America the first cases of HIV/AIDS was identified among certain high risk groups’ e.g. intravenous drug users, men having sex with men (MSM) etcs. HIV/AIDS is the common cause of death and morbidity among sexually active individuals in sub-Saharan Africa. The main objectives of this study was to assess the prevalence of HIV infection among patients attending four health centers in Dilla town from 2012-2014. Secondary data was obtained through assessing patients’ records at these facilities. The number of HIV infected individual highest at 2012 followed by 2014 and 2013, 47, 37 and 30 respectively in Selam Higher Clinic while, the highest number of HIV infected was 31, followed by 29 and 19 in the year of 2013, 2014 and 2012 respectively at Fitsum Medium Clinic. On the other hand, the highest number of HIV infected was 38, followed by 33 and 15 in the year of 2013, 2014 and 2012 at Muluneh Higher Clinic and the number of HIV infected at Hikma Medium Clinic the highest was 7 at 2013 followed at 2012 and 2014 at Hikma Medium Clinic. Generally, distribution of HIV infected individuals at those clinics was slightly decreased across the year even if the number of the voluntary counseling tests was increase in these clinics. Majority of the people that live with HIV virus were in their productive age (15-49 age) among both male and female. Acquired immunodeficiency syndrome has become one of the world’s most serious health and development challenges [1]. Within Sub-Saharan Africa, the AIDS epidemic was noticed first in central Africa [2]. Soon after, the epidemic was observed in East Africa, and subsequently in West Africa [3]. There is a great deal of similarity between the HIV virus and an the human immunodeficiency virus is a retrovirus closely related to the Simian Immunodeficiency Virus (SIV) which is responsible for clinical immunodeficiency in other non-human primates especially the Afrcian green monkey, although the SIV does not cause immune-suppression among monkeys. This apparent correlation has led to speculation among scientists that African hunters who butchered and ate monkeys (a traditional food source) might have been exposed to a mutated form of the virus that was infective to humans [4]. The discovery of human immunodeficiency virus (HIV) (the virus responsible for acquired immunodeficiency syndrome (AIDS) was in 1983 and the explosion of the AIDS epidemic that brought clinical virology to the forefront as a significant specialty [5]. Viruses infect all cellular life forms: eukaryotes (vertebrate animals, invertebrate animals, plants, fungi) and prokaryotes (bacteria and archaea) [5].

Safety and Immunogenicity of Modified Vaccinia Ankara-Bavarian Nordic Smallpox Vaccine in Vaccinia-Naive and Experienced Human Immunodeficiency Virus-Infected Individuals: An Open-Label, Controlled Clinical Phase II Trial.

BackgroundFirst- and second-generation smallpox vaccines are contraindicated in individuals infected with human immunodeficiency virus (HIV). A new smallpox vaccine is needed to protect this population in the context of biodefense preparedness. The focus of this study was to compare the safety and immunogenicity of a replication-deficient, highly attenuated smallpox vaccine modified vaccinia Ankara (MVA) in HIV-infected and healthy subjects.MethodsAn open-label, controlled Phase II trial was conducted at 36 centers in the United States and Puerto Rico for HIV-infected and healthy subjects. Subjects received 2 doses of MVA administered 4 weeks apart. Safety was evaluated by assessment of adverse events, focused physical exams, electrocardiogram recordings, and safety laboratories. Immune responses were assessed using enzyme-linked immunosorbent assay (ELISA) and a plaque reduction neutralization test (PRNT).ResultsFive hundred seventy-nine subjects were vaccinated at least once and had data available for analysis. Rates of ELISA seropositivity were comparably high in vaccinia-naive healthy and HIV-infected subjects, whereas PRNT seropositivity rates were higher in healthy compared with HIV-infected subjects. Modified vaccinia Ankara was safe and well tolerated with no adverse impact on viral load or CD4 counts. There were no cases of myo-/pericarditis reported.ConclusionsModified vaccinia Ankara was safe and immunogenic in subjects infected with HIV and represents a promising smallpox vaccine candidate for use in immunocompromised populations.

ORAL DISEASE IN FIVE PATIENTS INFECTED WITH HIV AND SCREENED FOR EPSTEIN-BARR VIRUS

Oral opportunistic infections can lead to a range of diseases in people who are living with human immunodeficiency virus (HIV). Among them, herpes viruses are responsible for common diseases in HIV positive people. Both benign and malignant oral diseases are associated with the Epstein-Barr virus (EBV). Five cases of oral lesions from a cohort of HIV positive patients were associated with EBV detection in the oral mucosa. Active EBV deoxyribonucleic acid (DNA) was detected in three of the samples. Of the two cases with herpes simplex type 1 (HSV-1)-like ulcers, only one was associated with EBV detection. Similarly, only one candidiasis case was also EBV DNA positive. Severe immunosuppression was found in the patient with candidiasis and hairy leukoplakia. This man, who harbored the EBV-2 strain, was also positive for EBNA-2 ribonucleic acid (RNA) message and showed several symptoms indicative of disease development. This study provides baseline data on the dynamics of opportunistic oral infections in HIV infected individuals in the era of highly active antiretroviral therapy (HAART), as well as the detection of EBV markers and their link with clinical outcome. DOI: http://dx.doi.org/10.17525/vrrjournal.v20i1.143

Cortical consequences of HIV-1 Tat exposure in rats are enhanced by chronic cocaine.

The life span of individuals that are sero-positive for human immunodeficiency virus (HIV) has greatly improved; however, complications involving the central nervous system (CNS) remain a concern. While HIV does not directly infect neurons, the proteins produced by the virus, including HIV transactivator of transcription (Tat), are released from infected glia; these proteins can be neurotoxic. This neurotoxicity is thought to mediate the pathology underlying HIVassociated neurological impairments. Cocaine abuse is common among HIV infected individuals, and this abuse augments HIV-associated neurological deficits. The brain regions and pathophysiological mechanisms that are dysregulated by both chronic cocaine and Tat are the focus of the current review.

Traditional risk factors are more relevant than HIV-specific ones for carotid intima-media thickness (cIMT) in a Brazilian cohort of HIV-infected patients.

BackgroundCombination antiretroviral therapy (cART) had a dramatic impact on the mortality profile in human immunodeficiency virus (HIV) infected individuals and increased their life-expectancy. Conditions associated with the aging process have been diagnosed more frequently among HIV-infected patients, particularly, cardiovascular diseases.MethodsPatients followed in the Instituto de Pesquisa Clínica Evandro Chagas (IPEC) prospective cohort in Rio de Janeiro were submitted to the general procedures from the Brazilian Longitudinal Study of Adult Health, comprising several anthropometric, laboratory and imaging data. Carotid intima-media thickness (cIMT) was measured by ultrasonography, following the Mannheim protocol. Linear regression and proportional odds models were used to compare groups and covariables in respect to cIMT. The best model was chosen with the adaptive lasso procedure.ResultsA valid cIMT exam was available for 591 patients. Median cIMT was significantly larger for men than women (0.56mm vs. 0.53mm; p = 0.002; overall = 0.54mm). In univariable linear regression analysis, both traditional risk factors for cardiovascular diseases (CVD) and HIV-specific characteristics were significantly associated with cIMT values, but the best multivariable model chosen included only traditional characteristics. Hypertension presented the strongest association with higher cIMT terciles (OR = 2.51; 95%CI = 1.69–3.73), followed by current smoking (OR = 1,82; 95%CI = 1.19–2.79), family history of acute myocardial infarction or stroke (OR = 1.60; 95%CI = 1.10–2.32) and age (OR per year = 1.12; 95%CI = 1.10–1.14).ConclusionsOur results show that traditional cardiovascular disease (CVD) risk factors are the major players in determining increased cIMT among HIV infected patients in Brazil. This finding reinforces the need for thorough assessment of those risk factors in these patients to guarantee the incidence of CVD events remain under control.

Abstract W P399: Magnetic Resonance Imaging Based Cerebral Blood Flow Changes in Asymptomatic Human Immunodeficiency Virus Infected Subjects

Background: Human Immunodeficiency Virus (HIV) infected individuals are at high risk for ischemic stroke. Magnetic resonance imaging (MRI) method of measurement of cerebral blood flow (CBF) and oxygen extraction fraction (OEF) may help assess the stroke risk in asymptomatic HIV subjects. Objectives: To evaluate MR measured CBF and OEF in treatment naïve asymptomatic HIV+ subjects and HIV- controls. Methods: Treatment naïve asymptomatic HIV+ subjects and age-gender-race matched HIV- controls were assessed for CBF using a pulsed arterial spin labeling (PASL) approach and Oxygen Extraction Fraction (OEF) using MRI T2*-weighted echo-planar imaging (EPI) sequences. All images were acquired using a Siemens 3T MR scanner (Treo, Siemens Medical Systems Inc). Quantitative CBF and OEF measurements were made in the whole-brain, gray matter and white matter and compared between the groups using unpaired t-test. Results: A total of 65 subjects of who, 35 treatment naïve HIV+ subjects (Mean age ± SD=30±7,89% male, 31% white, 49% black and 20% others) and 30 age-gender-race matched HIV- controls (Mean age± SD= 31±8,93% male, 37% white, 53% black and 10% others) consented to the protocol. HIV+ subjects compared to HIV- controls had significantly higher whole brain CBF (58.0 ± 13.8 ml/100g/min vs. 51.3 ± 9.0 ml/100g/min; p=0.03) and gray matter CBF (72.9 ± 16.2 ml/100g/min vs. 63.9 ± 9.9 ml/100g/min; p=0.01). However, values for whole brain OEF (0.4 ± 0.04) and gray matter OEF (0.4 ± 0.05) were similar for both groups. White matter CBF in HIV+ subjects (41.5 ± 13.1 ml/100g/min) compared to HIV- controls (37.2 ± 9.2 ml/100g/min) was not significantly higher (p=0.16) while white matter OEF (0.4 ± 0.04 HIV+ subjects vs. 0.4 ± 0.03 HIV-controls) showed no changes. Conclusions: The observed increase of whole brain CBF in treatment naïve HIV + subjects compared to HIV- matched controls, without corresponding changes in the OEF appears to be driven by a pronounced significant change in the gray matter compared with the white matter. These changes in CBF without corresponding changes in OEF suggest increase in metabolic activity, and may explain the higher stroke risk in asymptomatic HIV subjects.

Myocardial infarction among Danish HIV-infected individuals: population-attributable fractions associated with smoking.

Human immunodeficiency virus-infected individuals have increased risk of myocardial infarction (MI); however, the contribution from smoking and potentiating effects of HIV are controversial. From the Danish HIV Cohort Study and the Copenhagen General Population Study, we identified 3251 HIV-infected individuals and 13 004 population controls matched on age and gender. Data on MI were obtained from the National Hospital Registry and the National Registry of Causes of Death. We calculated adjusted incidence rate ratios (aIRR) for risk of MI and population-attributable fractions (PAF) of MI associated with smoking. In never smokers, HIV was not associated with an increased risk of MI (aIRR, 1.01; 95% confidence interval [CI], .41-2.54). In previous and current smokers, HIV was associated with a substantially increased risk of MI (aIRR, 1.78; 95% CI, .75-4.24 and aIRR, 2.83; 95% CI, 1.71-4.70). The PAF associated with ever smoking (previous or current) was 72% (95% CI, 55%-82%) for HIV-infected individuals and 24% (95% CI, 3%-40%) for population controls. If all current smokers stopped smoking, 42% (95% CI, 21%-57%) and 21% (95% CI, 12%-28%) of all MIs could potentially be avoided in these 2 populations. Smoking is associated with a higher risk of MI in the HIV-infected population than in the general population. Approximately 3 of 4 MIs among HIV-infected individuals are associated with ever smoking compared with only 1 of 4 MIs among population controls. Smoking cessation could potentially prevent more than 40% of MIs among HIV-infected individuals, and smoking cessation should be a primary focus in modern HIV care.

Malnutrition and Associated Factors among Adult Individuals Receiving Highly Active Antiretroviral Therapy in Health Facilities of Hosanna Town, Southern Ethiopia

Background: In resource limited settings, many human immunodeficiency virus (HIV) infected individuals lack access to sufficient quantities of nutritious foods, which poses additional challenges to the success of anti-retroviral therapy. Morbidity and mortality related to human immune deficiency virus infection in the developing world remain unacceptably high, despite major advances in human immune deficiency virus therapy and increased international funding for care. Objective: To determine magnitude of malnutrition and identify factors associated with it among adult people on highly active anti-retroviral therapy (HAART) in health facility of Hosanna town. Methods: Institutional based cross-sectional survey was conducted from March 20 to April30, 2014 on 340 adult people on anti-retroviral therapy at antiretroviral therapy clinics of Hosanna town. Sample clients were selected by simple random sampling technique. Data were collected by face-to-face interview using structured pretested questionnaire, record review using check list and anthropometric measurements. Bi-variate analysis and multivariable logistic regression models were done using SPSS version 16 to identify factors associated with malnutrition. Results: Overall, the prevalence of malnutrition (Body Mass Index (BMI) < 18.5 kg/m2) in this study was 31.2%. Household food insecurity (AOR = 2.51, 95% CI: 1.31 - 4.81), inadequate diversified diet (AOR = 0.44, 95% CI: 0.23 - 0.84), low meal frequency (AOR = 0.29, 95% CI: 0.11 - 0.76), clinical staging four (AOR = 5.23, 95% CI: 1.42 - 19.35), clinical staging three (AOR = 3.91, 95% CI: 1.57, 9.73), presence of opportunistic infections (AOR = 2.62, 95% CI: 1.49 - 4.59) and nutritional support (AOR = 0.45, 95% CI: 0.23 - 0.89) were independent predictors of malnutrition. Conclusion: Malnutrition (BMI < 18.5 kg/m2) was high in adult people on anti-retroviral therapy at anti-retroviral therapy clinics of Hossana town. Only Anti-Retroviral Therapy is not enough to improve the health status of people on HAART. Further, interventional initiatives should focus in improving household food security, diversity of diet, meal frequency, clinical staging and prevention and control of opportunistic infections in adult HIV infected individuals receiving highly active anti-retroviral therapy.

Viral hepatitis and human immunodeficiency virus co-infections in Asia.

Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) affect many people in Asian countries, although there are geographic differences. Both HBV and HIV (HBV/HIV) and HCV/HIV co-infections are highly prevalent in Asia. Hetero- and homosexual, injection drug use, and geographic area are strong predictors of HBV, HCV, and HIV serostatus. In HBV endemic regions, the prevalence and genotype distribution of HBV/HIV co-infection is almost comparable with that in the general population. In Japan, where HBV has low endemicity, the prevalence of HBV/HIV co-infection is approximately 10-fold higher than that in the general population, and HBV Ae is the most common subgenotype among HIV infected individuals. Highly active antiretroviral therapy (HAART) is an effective treatment for HIV/Acquired Immune Deficiency Syndrome. Lamivudine, a component of HAART, is an effective treatment for HBV, HIV, and HBV/HIV co-infection; however, cost, emerging drug resistance, antiretroviral-associated liver toxicity and liver-related morbidity due to HCV progression are particular concerns. HCV/HIV co-infection may accelerate the clinical progression of both HCV and HIV. The high prevalence of HBV/HIV and HCV/HIV co-infections in Asia underscores the need to improve prevention and control measures, as fewer evidence-based prevention strategies are available (compared with Western countries). In this review, the most recent publications on the prevalence of HBV/HIV and HCV/HIV co-infections and related issues, such as therapy and problems in Asia, are updated and summarized.

High-resolution anoscopy: Unchartered territory for gastroenterologists?

High-resolution anoscopy (HRA) is a procedure where patients with an increased risk of anal cancer, like men who have sex with men, human immunodeficiency virus infected individuals, transplant patients and women with a history of lower genital tract neoplasia, with abnormal anal cytology results, are submitted to anal and perianal visualization under magnification. This will allow for a better detection of anal high-grade lesions that can be treated, in an effort to prevent anal cancer. Anal cancer screening follows the same principles that cervical cancer screening. During this procedure, an anoscope is inserted and a colposcope is used to examine systematically the squamocolumnar junction, the transformation zone and the perianal skin. Initially the observation is done with no staining and then with the application of acetic acid and Lugol's iodine solution, allowing for better lesion identification and characterization. Any suspicious lesion seen should be carefully evaluated and biopsied. Without HRA only a small percentage of suspicious lesions are identified. High-grade lesions that are detected can be ablated under HRA. This is a challenging exam to perform, with a long learning curve and the number of clinicians performing it is limited, although the growing number of patients that need to been screened. Specific equipment is required, with these patients ideally been followed by a multidisciplinary team, in a reference centre. HRA remains unfamiliar for many gastroenterologists.

Uveitis in human immunodeficiency virus-infected individuals.

Supported by Australian Research Council (FT130101648). The authors declare that they have no conflicts of interest to disclose.

Ascertaining in vivo virulence of Mycobacterium tuberculosis lineages in patients in Mbeya, Tanzania.

We evaluated the relationship between the degree of immunodeficiency indicated by the number of circulating CD4+ T-cells and Mycobacterium tuberculosis lineages identified by spoligotyping and mycobacterial interspersed repetitive units-variable number of tandem repeats genotyping in human immunodeficiency virus (HIV) infected individuals with pulmonary tuberculosis from Mbeya, Tanzania. Of M. tuberculosis strains from 129 patients, respectively 55 (42.6%) and 37 (28.7%) belonged to Latin American Mediterranean and Delhi/Central-Asian lineages, while 37 (28.7%) patients were infected with other strains. There was no difference in the distribution of M. tuberculosis lineages among patients with early or advanced stages of HIV infection (P = 0.785), indicating that the virulence of strains from these lineages may not be substantially different in vivo.

Hepatitis C in human immunodeficiency virus co-infected individuals: Is this still a "special population"?

A substantial proportion of individuals with chronic hepatitis C virus (HCV) are co-infected with human immunodeficiency virus (HIV). Co-infected individuals are traditionally considered as one of the "special populations" amongst those with chronic HCV, mainly because of faster progression to end-stage liver disease and suboptimal responses to treatment with pegylated interferon alpha and ribavirin, the benefits of which are often outweighed by toxicity. The advent of the newer direct acting antivirals (DAAs) has given hope that the majority of co-infected individuals can clear HCV. However the "special population" designation may prove an obstacle for those with co-infection to gain access to the new agents, in terms of requirement for separate pre-licensing clinical trials and extensive drug-drug interaction studies. We review the global epidemiology, natural history and pathogenesis of chronic hepatitis C in HIV co-infection. The accelerated course of chronic hepatitis C in HIV co-infection is not adequately offset by successful combination antiretroviral therapy. We also review the treatment trials of chronic hepatitis C in HIV co-infected individuals with DAAs and compare them to trials in the HCV mono-infected. There is convincing evidence that HIV co-infection no longer diminishes the response to treatment against HCV in the new era of DAA-based therapy. The management of HCV co-infection should therefore become a priority in the care of HIV infected individuals, along with public health efforts to prevent new HCV infections, focusing particularly on specific patient groups at risk, such as men who have sex with men and injecting drug users.

Mortality and Risk Stratification of HIV Infected Individuals.

For the first decade and a half after the Human Immunodeficiency Virus (HIV) was first identified, the prognosis for most people infected with HIV was quite poor. Life insurance companies responded accordingly and insurance laboratories developed new means to test for the infection. However, it is now clear that people with HIV infection are living longer and that the majority of deaths occurring among those on treatment are now no longer due to AIDS-defining illnesses. This review examines the results of selected studies which analyzed mortality outcomes in those with HIV infection, the many factors which influence those outcomes, and the limitations in the data and in their applicability to an insurance population.

Diversity and antifungal resistance patterns of prevalent opportunistic pathogenic yeasts colonizing the oral cavities of asymptomatic human immunodeficiency virus-infected individuals, and their relation to CD4(+) counts.

Yeasts are important opportunistic pathogens, in individuals infected with human immunodeficiency virus (HIV). Yeast species inhabiting the oral mucosa of HIV-infected persons can act as source of oral lesions, especially as the individual progresses towards immunocompromised state. Present study was conducted to evaluate the diversity of yeasts in oral cavities of asymptomatic HIV-infected persons and their association with CD4(+) cell counts. 100 HIV seropositive subjects and 100 healthy controls were screened for oral yeast carriage using standard procedures. Of the 100 HIV-seropositive persons screened, 48 were colonized by different yeasts, either alone or in association with another species. Candida albicans was the most common species (56.90%) while non C. albicans Candida (NCAC) accounted for 39.65%. Among NCAC, Candida tropicalis and Candida krusei were most common. One isolate each of rare opportunistic pathogenic yeasts, Geotrichum candidum and Saccharomyces cereviseae, was recovered. The control group had an oral candidal carriage rate of 23%; C. albicans was the predominant species, followed by Candida glabrata, C. tropicalis and Candida parapsilosis. Antifungal susceptibility testing revealed no resistance in C. albicans, to the commonly used antifungal agents, whereas resistance or dose dependent susceptibility to fluconazole was observed in some of the NCAC species. Oral carriage of opportunistic pathogenic yeasts was greater in HIV-seropositive persons heading towards immunocompromised state, as evidenced by their CD4(+) cell count. The predominant yeast isolated in this study (C. albicans), was found to be susceptible to commonly used antifungals.

Diversity and antifungal resistance patterns of prevalent opportunistic pathogenic yeasts colonizing the oral cavities of asymptomatic human immunodeficiency virus-infected individuals, and their relation to CD4+ counts

Background:Yeasts are important opportunistic pathogens, in individuals infected with human immunodeficiency virus (HIV). Yeast species inhabiting the oral mucosa of HIV-infected persons can act as source of oral lesions, especially as the individual progresses towards immunocompromised state. Present study was conducted to evaluate the diversity of yeasts in oral cavities of asymptomatic HIV-infected persons and their association with CD4+ cell counts.Materials and Methods:100 HIV seropositive subjects and 100 healthy controls were screened for oral yeast carriage using standard procedures.Results:Of the 100 HIV-seropositive persons screened, 48 were colonized by different yeasts, either alone or in association with another species. Candida albicans was the most common species (56.90%) while non C. albicans Candida (NCAC) accounted for 39.65%. Among NCAC, Candida tropicalis and Candida krusei were most common. One isolate each of rare opportunistic pathogenic yeasts, Geotrichum candidum and Saccharomyces cereviseae, was recovered. The control group had an oral candidal carriage rate of 23%; C. albicans was the predominant species, followed by Candida glabrata, C. tropicalis and Candida parapsilosis. Antifungal susceptibility testing revealed no resistance in C. albicans, to the commonly used antifungal agents, whereas resistance or dose dependent susceptibility to fluconazole was observed in some of the NCAC species.Conclusion:Oral carriage of opportunistic pathogenic yeasts was greater in HIV-seropositive persons heading towards immunocompromised state, as evidenced by their CD4+ cell count. The predominant yeast isolated in this study (C. albicans), was found to be susceptible to commonly used antifungals.

Clinical trial for evaluation of a Human Immunodeficiency Virus nosode in the treatment for Human Immunodeficiency Virus-Infected individuals

Introduction: Identifying the need for strengthening of the immune system, the investigator has developed new Human Immunodeficiency Virus (HIV) nosode and evaluated its effect on HIV positive individuals through a clinical trial. Methods: Standardized and the scientific method of HIV nosode preparation has been described and documented. Thirty-seven HIV-infected persons were registered for the trial, and ten participants were dropped out from the study, so the effect of HIV nosode 30C and 50C, was concluded on 27 participants under the trial. Results: Out of 27 participants, 7 (25.93%) showed a sustained reduction in the viral load from 12 to 24 weeks. Similarly 9 participants (33.33%) showed an increase in the CD4+ count by 20% altogether in 12 th and 24 th week. Significant weight gain was observed at week 12 (P = 0.0206). 63% and 55% showed an overall increase in either appetite or weight. The viral load increased from baseline to 24 week through 12 week in which the increase was not statistically significant (P > 0.05). 52% (14 of 27) participants have shown either stability or improvement in CD4% at the end of 24 weeks, of which 37% participants have shown improvement (1.54-48.35%) in CD4+ count and 15% had stable CD4+ percentage count until week 24 week. 16 out of 27 participants had a decrease (1.8-46.43%) in CD8 count. None of the adverse events led to discontinuation of study. Conclusion: The study results revealed improvement in immunological parameters, treatment satisfaction, reported by an increase in weight, relief in symptoms, and an improvement in health status, which opens up possibilities for future studies.

Serum protein electrophoresis patterns in human immunodeficiency virus-infected individuals not on antiretroviral treatment.

B lymphocyte stimulation is described in human immunodeficiency virus (HIV) infection and results in ongoing immunoglobulin production with abnormal serum protein electrophoresis patterns. We hypothesized that serum protein electrophoresis patterns would be abnormal in untreated HIV subjects and correlate with markers of disease severity. Serum protein electrophoresis was performed on 70 HIV-positive, clinically well treatment-naïve subjects and 42 HIV-negative controls and correlated with markers of disease severity, namely CD4+ counts, viral loads, IgG and albumin. The mean age for both groups was 33 years, and female-to-male ratios were 4:1. All were of Black ethnicity. Mean CD4 counts ± SD for HIV group and controls were 419.5 ± 218.6 and 960.4 ± 378.5 cells/mm(3), respectively. Of the HIV-infected group, 44% showed polyclonal hypergammaglobulinaemia versus 10% of controls (P < 0.01). The HIV group had 27% with an abnormal pattern requiring immunofixation which revealed nine (12.5% of total) had oligoclonal bands, seven (10.3% of total) had polyclonal hypergammaglobulinaemia and three (4% of total) had monoclonal bands. CD4+ counts were lower in those with polyclonal hypergammaglobulinaemia or abnormal serum protein electrophoresis. Interestingly, viral load results showed no statistically significant differences. We found a remarkably high level (53%) of polyclonal hypergammaglobulinaemia in our untreated population compared with uninfected controls (10%). Only 4% of the HIV-positive group had a monoclonal band. Polyclonal hypergammaglobulinaemia correlated significantly with lower CD4+ counts. These results highlight the generalized B cell stimulation in untreated HIV infection. Future longitudinal studies will be important to determine the prognostic value of these findings.

Influence of the Timing of Antiretroviral Therapy on the Potential for Normalization of Immune Status in Human Immunodeficiency Virus 1–Infected Individuals

ImportanceIn individuals with human immunodeficiency virus 1 (HIV-1) infection who are receiving antiretroviral therapy (ART), factors that promote full immune recovery are not well characterized. ObjectiveTo investigate the influence of the timing of ART relative to HIV-1 infection on normalization of CD4+ T-cell counts, AIDS risk, and immune function.Design, Setting, and ParticipantsParticipants in the observational US Military HIV Natural History Study with documented estimated dates of seroconversion (EDS) who achieved virologic suppression with ART were evaluated. Markers indicative of immune activation, dysfunction, and responsiveness were determined. Responses to hepatitis B virus (HBV) vaccine, an indicator of in vivo immune function, were also assessed. The timing of ART was indexed to the EDS and/or entry into the cohort. The CD4+ counts in HIV-1–uninfected populations were surveyed.Main Outcomes and MeasuresNormalization of CD4+ counts to 900 cells/μL or higher, AIDS development, HBV vaccine response, as well as T-cell activation, dysfunction, and responsiveness.ResultsThe median CD4+ count in HIV-1–uninfected populations was approximately 900 cells/μL. Among 1119 HIV-1–infected participants, CD4+ normalization was achieved in 38.4% vs 28.3% of those initiating ART within 12 months vs after 12 months from the EDS (P = .001). Incrementally higher CD4+ recovery (<500, 500-899, and ≥900 cells/μL) was associated with stepwise decreases in AIDS risk and reversion of markers of immune activation, dysfunction, and responsiveness to levels approximating those found in HIV-1–uninfected persons. Participants with CD4+ counts of 500 cells/μL or higher at study entry (adjusted odds ratio [aOR], 2.00; 95% CI, 1.51-2.64; P < .001) or ART initiation (aOR, 4.08; 95% CI, 3.14-5.30; P < .001) had significantly increased CD4+ normalization rates compared with other participants. However, even among individuals with a CD4+ count of 500 cells/μL or higher at both study entry and before ART, the odds of CD4+ normalization were 80% lower in those initiating ART after 12 months from the EDS and study entry (aOR, 0.20; 95% CI, 0.07-0.53; P = 001). Initiation of ART within 12 months of EDS vs later was associated with a significantly lower risk of AIDS (7.8% vs 15.3%; P = .002), reduced T-cell activation (percent CD4+HLA-DR+ effector memory T cells, 12.0% vs 15.6%; P = .03), and increased responsiveness to HBV vaccine (67.9% vs 50.9%; P = .07).Conclusions and RelevanceDeferral of ART beyond 12 months of the EDS diminishes the likelihood of restoring immunologic health in HIV-1–infected individuals.