Human Immunodeficiency Virus Co-infected Patients Research Articles

Decreased in Liver Fibrosis in Patients with HCV/HIV Coinfection After Treatment with Sofosbuvir/Daclatasvir

Background: Hepatitis C Virus (HCV)/Human Immunodeficiency Virus (HIV) co-infection increases the progression of liver fibrosis to advanced liver disease and death. The aim of this study is to determine whether decreased of liver fibrosis occur in HCV/HIV coinfection patients after therapy with Sofosbuvir/daclatasvir. Method: This study used a quasi-experimental study design without a control group. The study subjects were HCV/HIV coinfection patients who received Sofosbuvir / daclatasvir therapy in the Gastroentero-Hepatology Clinic of Dr. Hasan Sadikin Hospital. In this study measurement of liver fibrosis was carried out by using AST to Platelet Ratio Index (APRI) and Fibrosis-4 Index (FIB-4) before therapy and when SVR-24 was achieved.Results: The study involved 29 subjects. Most of the research subjects were men, with an average age of 40.38 years (SD 3.48). From the results of this study, we found a decrease in APRI scores and FIB-4 index when HCV / HIV coinfection patients, that were treated with Sofosbuvir/ Daclatasvir, achieved SVR 24. The median of APRI scores before therapy and after SVR-24 was decreased from 0.41 to 0.28 (95% CI: 0.01 - 0.23, p-value 0,01) and the median of FIB-4 Index before therapy and after the SVR 24 was decreased from 0.94 to 0.81 (95% CI: -0, 04 - 0.35, p-value 0.28).Conclusion: This study concluded that therapy using Sofosbuvir / Daclatasvir in HCV / HIV coinfected patients has very good effectiveness and can reduce liver fibrosis.

GeneXpert Technology for the diagnosis of HIV-associated tuberculosis: Is scale-up worth it?

Recent evaluations of the GeneXpert MTB/RIF assay for the simultaneous detection of Mycobacterium tuberculosis and drug resistance in less than 2 h have stimulated tremendous enthusiasm. This is the breakthrough that tuberculosis (TB) control has been waiting for. In this (retrospective review) case study, sputum samples from strongly suspected pulmonary tuberculosis patients were collected and assessed for the GeneXpert MTB/RIF assay for diagnosing TB and drug resistance in comparison with other tests, including Ziehl–Neelsen smear and Löwenstein–Jensen test. Of 3,784 cases, 5.7% (216/3,784) were human immunodeficiency virus (HIV)-positive and TB co-infected patients. In diagnosing HIV-positive and TB co-infected cases, the sensitivity and specificity of GeneXpert were 76.4% and 100%. While in HIV-negative and TB suspected cases, the sensitivity and specificity were 95.6% and 100%. This new test represents a major milestone for global TB diagnosis and care. It also represents new hope for the millions of people who are at the highest risk of TB and drug-resistant disease. GeneXpert is World Health Organization-endorsed technology representing the gold standard for TB testing despite attaining less sensitivity for HIV and TB co-infected patients as compared to HIV-negative patients.

Study of Rifampicin resistant pattern of Mycobacterium tuberculosis and Human immunodeficiency virus co-infected patients using Gene-Xpert assay

Study of Rifampicin resistant pattern of Mycobacterium tuberculosis and Human immunodeficiency virus co-infected patients using Gene-Xpert assay

Ocular Tuberculosis in Human Immunodeficiency Virus and Systemic Tuberculosis Co-infected Patients

ABSTRACT Purpose: To describe the prevalence and clinical findings of ocular tuberculosis (TB) in Human immunodeficiency virus (HIV) and systemic TB co-infected patients. Methods: In this prospective, observational, non-comparative case series, we included HIV and systemic TB co-infected patients, who underwent a detailed ophthalmic and systemic evaluation. Results: Of 85 patients, ocular tuberculosis was seen in eleven patients and their 16 eyes (12.9%). Without the benefit of eye exam, the diagnosis of disseminated TB was missed in 5/52 (9.6%) and 2/25 (8%) of patients clinically assumed to have pulmonary and Extrapulmonary TB, respectively. Conclusion: HIV patients with the disseminated TB have higher risk for ocular TB. As ocular symptoms are rare, still all of them need a detailed ocular examination to look for active ocular TB which will reclassify isolated pulmonary/extrapulmonary to disseminated TB warranting a detailed systemic examination.

Oxidative stress in hepatitis C virus–human immunodeficiency virus co-infected patients

Introduction and objectivesHuman immunodeficiency virus (HIV) and hepatitis C virus (HCV) co-infection generates sustained inflammation with increased reactive oxygen species production. The pathogenic impact of systemic oxidative stress is known to influence drug treatment and follow-up. The aim of this case–control study was to compare the redox status in HCV–HIV co-infected with respect to HIV-infected individuals and to explore the relation between redox and HIV follow-up variables. Patients or materials and methodsBlood samples were drawn from 330 individuals divided into three groups: HIV, HCV–HIV and presumable healthy subjects. Redox, hematological, hemochemical, immunologic and virological indexes were determined. ResultsBoth HIV groups had significant differences in global indexes of damage and antioxidant status (p<0.05) with respect to the supposedly healthy individual group. HCV–HIV group showed a significantly higher damage (total hydroperoxide and advanced oxidation protein products) compared to the control and HIV groups (p<0.05). The overall modification of the redox indexes showed that 72% of individuals with simultaneous detrimental differences were related to HCV–HIV condition. ConclusionsThese results corroborate that oxidative stress occurs in the HIV condition and also during HCV–HIV co-infection, with different molecular changes of follow-up indexes. Redox indexes diagnosis should be considered in early diagnosis and treatment of HCV–HIV co-infection.

Biochemical and Hematological Impact of Hepatitis C Virus (HCV) on Human Immunodeficiency Virus (HIV) Infected Persons on Antiretroviral Drugs (ARDs) in Nigeria

Introduction: Biochemical and hematological abnormalities are among most common clinico-pathological manifestations of HIV/AIDS infected persons on antiretroviral drugs (ARDs). Hepatitis C Virus (HCV) infection are known to influence progression and management of HIV infection. Data are limited regarding the impact of ARDs on HIV/HCV co-infected persons in Nigeria. Hence, this study evaluated the biochemical and hematological impact of HCV on prognosis of HIV persons taking ARDs.&#x0D; Materials and Methods: 2,322 HIV infected persons were screened for HCV. One hundred and nine were co-infected with HCV; and were cross-sectional monitored on ARDs for fifteen months at hospitals in North Central Nigeria for changes in clinical profiles. The determination of Alanine aminotransferase (ALT), Aspartate transaminase (AST), Packed cell volume (PCV) and White blood cells count (WBC) estimations were reviewed every 3 months for each of the person using Reflotron plus machine and hematological analyzer according to the manufacturer’s instructions.&#x0D; Results: The results showed an increase in both HIV mono-infected and co-infected patients, with raised in AST from 18.46±0.73 to 34.32±0.6053U/l, ALT from 19.37±0.6804 to 34.87±0.5637U/l, PCV from 34.20±0.2998 to 34.89±0.4895% and WBC from 3.50x109±0.0816 to 6.67x109±0.1204 cells/L and AST from 17.35±0.1542 to 34.49±0.0981U/l, ALT from 17.67±0.1412 to 34.80±0915U/l, PCV from 36.74±0.2902 to 38.37±0.4399% and WBC from 3.90x109±0.0251 to 6.19x109±0.0178 cells/L.&#x0D; Conclusion: It was found that PCV and WBC count values were positively affected despite HCV replication and AST and ALT enzyme levels for both HIV-mono and co-infected persons were slightly elevated. Therefore, efforts addressing viral hepatitis co-infections at the early stage of ARDs initiation under qualified clinician should be of paramount important.

Evaluating Noninvasive Markers to Identify Advanced Fibrosis by Liver Biopsy in HBV/HIV Co-infected Adults.

Noninvasive biomarkers are used increasingly to assess fibrosis in patients with chronic liver disease. We determined the utility of dual cutoffs for noninvasive biomarkers to exclude and confirm advanced fibrosis in hepatitis B virus (HBV)-human immunodeficiency virus (HIV) co-infected patients receiving combined antiretroviral therapy. Participants were anti-HIV/hepatitis B surface antigen-positive adults from eight clinical sites in the United States and Canada of the Hepatitis B Research Network. Fibrosis was staged by a central pathology committee using the Ishak fibrosis score (F). Clinical, laboratory, and vibration-controlled transient elastography (VCTE) data were collected at each site. Dual cutoffs for three noninvasive biomarkers (aspartate aminotransferase-to-platelet ratio index, Fibrosis-4 index [FIB-4], and liver stiffness by VCTE) with the best accuracy to exclude or confirm advanced fibrosis (F≥3) were determined using established methodology. Of the 139 enrolled participants, 108 with a liver biopsy and having at least one noninvasive biomarker were included: 22% had advanced fibrosis and 54% had normal alanine aminotransferase. The median (interquartile range) of APRI (n=106), FIB-4 (n=106), and VCTE (n=63) were 0.34 (0.26-0.56), 1.35 (0.99-1.89), and 4.9 (3.8-6.8) kPa, respectively. The area under the curve for advanced fibrosis was 0.69 for APRI, 0.66 for FIB-4, and 0.87 for VCTE. VCTE cutoffs of 5.0kPa or less (to exclude) and 8.8kPa or greater (to confirm) advanced fibrosis had a sensitivity of 92.3% and specificity of 96.0%, respectively, and accounted for 65.1% of participants. Among the 34.9% with values between the cutoffs, 26.1% had advanced fibrosis. Considering APRI or FIB-4 jointly with VCTE did not improve the discriminatory capacity. Conclusion: VCTE is a better biomarker of advanced fibrosis compared with APRI or FIB-4 in HBV/HIV co-infected adults on combined antiretroviral therapy. Using VCTE dual cutoffs, approximately two-thirds of patients could avoid biopsy to determine advanced fibrosis.

Low compliance with hepatocellular carcinoma screening guidelines in hepatitis B/C virus co-infected HIV patients with cirrhosis.

The incidence of hepatocellular carcinoma (HCC) in patients co-infected with HIV and hepatitis B virus (HBV) or hepatitis C virus (HCV) is increasing. In patients with cirrhosis, guidelines recommend HCC screening every 6 months. We assessed compliance with HCC screening guidelines in cirrhotic HBV/HCV-HIV-co-infected patients. HBV/HCV-HIV-co-infected patients with cirrhosis were enrolled from 4 European prospective cohorts participating in the COHERE collaboration, followed from 1 January 2005-1 January 2015. Assessment of liver cirrhosis was based on clinical diagnosis and liver biopsy or Fibroscan. Compliance with HCC screening guidelines was defined as one ultrasound every 6 months. Generalized estimating equation models adjusted for repeated measurements were fitted to determine predictors of low compliance. Different sensitivity analyses were performed and validation of the data was carried out by randomly checking 10% of each cohort's data. 646 HIV-patients with the diagnosis of cirrhosis were included: 518 (80%) HCV-, 85 (13%) HBV- and 43 (7%) HBV/HCV-co-infected. Median age at cirrhosis diagnosis was 44 years, median follow-up time since diagnosis was 5.3 years. Screening </=6 months was performed in 6-18% of individuals from 2005-2015. If the screening interval was increased to 9 or 12 months, compliance improved to 7-24% and 7-30% respectively. Thus, compliance with HCC screening guidelines in cirrhotic HIV-patients co-infected with HBV and/or HCV in Europe is low. In light of an ageing population and the increasing prevalence of liver cirrhosis this situation needs to be addressed urgently. This article is protected by copyright. All rights reserved.

High prevalence of multi drug resistant tuberculosis in people living with HIV in Western India

BackgroundMost studies assessing drug resistant tuberculosis (DRTB) in human immunodeficiency virus (HIV) co-infected patients in India have used conventional culture- based systems to diagnose DRTB that have a longer turnaround time leading to risk of amplification of resistance to an empirical regimen. We determined the prevalence of DRTB amongst people living with HIV (PLHIV) using the line probe assay and determined risk factors associated with the presence of multi drug resistant tuberculosis (MDRTB).MethodsA Cross-sectional study was undertaken at Poona Hospital and Research Center (PHRC) and the Institute of Infectious Diseases, two tertiary level private care centers in Pune, India. Consenting PLHIV with confirmed Pulmonary TB (PTB) and/or extra-pulmonary TB (EPTB) diagnosed based on detection of Mycobacterium TB by line probe assay (Geno Type MTBDRplus version 2) on clinical specimens were included. Those with documented past history of DRTB were excluded. Resistance against anti-TB drugs was determined by the same assay. The prevalence of any form of drug resistant TB (DRTB), MDRTB, Rifampicin resistant TB (RRTB) and Isoniazid (INH) mono-resistant TB were determined as the proportion of these amongst all included PLHIV-TB. A multivariate analysis was conducted to determine risk factors that were statistically associated with MDRTB, DRTB, RRTB and INH mono-resistant TB.ResultsTwo hundred PLHIV were recruited. The prevalence (95% CI) of MDRTB, INH mono- resistance and RR resistance was 12.5% (7.9–17.1%), 9% (6.9–11.2%) and 2.5% (1.4–3.6%), respectively. The prevalence (95% CI) of MDRTB among new and relapsed patients was 8.8% (6.5–11.1%) and 23.1% (17.2–28.9%), respectively. Tuberculosis relapse was the only factor significantly associated with MDRTB, DRTB and INH mono-resistant TB.ConclusionWe document a high prevalence of drug resistance to anti-TB drugs including MDRTB among PLHIV in our setting using Geno Type MTBDRplus directly on clinical specimens. This validates the WHO recommendation of performing routine rapid molecular resistance testing prior to initiating anti-TB treatment among all PLHIV with presumptive TB. Using rapid molecular testing especially Geno Type MTBDRplus (that detects resistance to INH and Rifampicin simultaneously) reduces the turn-around time helping in optimizing treatment.

A randomized trial of AmBisome monotherapy and AmBisome and miltefosine combination to treat visceral leishmaniasis in HIV co-infected patients in Ethiopia.

BackgroundVisceral leishmaniasis (VL) in human immunodeficiency virus (HIV) co-infected patients requires special case management. AmBisome monotherapy at 40 mg/kg is recommended by the World Health Organization. The objective of the study was to assess if a combination of a lower dose of AmBisome with miltefosine would show acceptable efficacy at the end of treatment.Methodology/Principal findingsAn open-label, non-comparative randomized trial of AmBisome (30 mg/kg) with miltefosine (100 mg/day for 28 days), and AmBisome monotherapy (40 mg/kg) was conducted in Ethiopian VL patients co-infected with HIV (NCT02011958). A sequential design was used with a triangular continuation region. The primary outcome was parasite clearance at day 29, after the first round of treatment. Patients with clinical improvement but without parasite clearance at day 29 received a second round of the allocated treatment. Efficacy was evaluated again at day 58, after completion of treatment.Recruitment was stopped after inclusion of 19 and 39 patients in monotherapy and combination arms respectively, as per pre-specified stopping rules. At D29, intention-to-treat efficacy in the AmBisome arm was 70% (95% CI 45–87%) in the unadjusted analysis, and 50% (95% CI 27–73%) in the adjusted analysis, while in the combination arm, it was 81% (95% CI 67–90%) and 67% (95% CI 48–82%) respectively. At D58, the adjusted efficacy was 55% (95% CI 32–78%) in the monotherapy arm, and 88% (95% CI 79–98%) in the combination arm.No major safety concerns related to the study medication were identified. Ten SAEs were observed within the treatment period, and 4 deaths unrelated to the study medication.Conclusions/SignificanceThe extended treatment strategy with the combination regimen showed the highest documented efficacy in HIV-VL patients; these results support a recommendation of this regimen as first-line treatment strategy for HIV-VL patients in eastern Africa.Trial registration numberwww.clinicaltrials.gov NCT02011958.

2209. Discordance Between FibroSure and FibroScan Results in Hepatitis C and Human Immunodeficiency Virus Co-infected Patients Prior to Treatment for Hepatitis C Virus Infection

BackgroundThe accurate diagnosis of hepatitis C virus (HCV)-related fibrosis is crucial for prognosis and treatment decisions. FibroSure and FibroScan are commonly used to approximate fibrosis prior to HCV treatment. Both methods have been validated for their correlation to the five-level (F0–F4) METAVIR scoring system. However, the correlation between these two tests in HIV/HCV co-infected patients has not been well described. Here, we evaluated the concordance between FibroSure and FibroScan-derived METAVIR results in HIV/HCV co-infected patients.MethodsWe performed a retrospective cross-sectional study of HIV/HCV co-infected patients that were treated between 2014 and 2017 at Drexel University, Philadelphia, PA. We described patient demographics and overall METAVIR scores of treated patients. Further, we compared the concordance between FibroSure and FibroScan results among patients who had both tests before the start of HCV treatment.ResultsOne hundred and thirty-eight HIV/HCV co-infected patients were treated. Most of them (N = 134, 97%) achieved sustained virologic response after 12 weeks of treatment. One hudred and thirty-three patients underwent FibroSure testing before starting HCV treatment. Of those, 62 (47%) fell in the F0–F2 range and 71 (53%) in the F3–F4 range. Of those 133 patients, 21 also underwent FibroScan. Fourteen (67%) fell in the F0–F2 range, while seven (33%) fell in the F3–F4 range. Of the 21 patients who both had FibroSure and FibroScan testing, 12 (57%) had concordant results, while nine (42%) had discrepant results. Of the patients with discrepant results, eight had higher fibrosis scores (F3–F4) with FibroSure, while only one had a higher fibrosis score (F3–F4) with FibroScan.ConclusionIn our study, more than half of HIV/HCV co-infected patients had advanced fibrosis score at the time of HCV treatment. When FibroSure and FibroScan scores were compared, close to half of co-infected patients had discordant results, the preponderance of which had higher FibroSure scores. As early initiation of HCV treatment is crucial to co-infected patients, further studies will need to evaluate the clinical significance of the discrepancy between different non-invasive fibrosis testing systems in co-infected patients.Disclosures All authors: No reported disclosures.

A mortality review of tuberculosis and HIV co-infected patients in Mahalapye, Botswana: Does cotrimoxazole preventive therapy and/or antiretroviral therapy protect against death?

BackgroundThe World Health Organization aims to reduce tuberculosis (TB) mortality rate from 15% in 2015 to 6.5% by 2025.AimThis study determined the profile of TB and human immunodeficiency virus (HIV) co-infected patients who died in Mahalapye District, Botswana, while on anti-TB medication and the factors that contributed to such outcome.SettingThe study was conducted in the Mahalapye Health District in Botswana.MethodsThis was a cross-sectional study that reviewed patient records from the Mahalapye District Health Management Team Electronic Tuberculosis Register from January 2013 to December 2015.ResultsThe majority of the TB and HIV co-infected patients were on antiretroviral therapy (ART) (486 [81.63%]) or were initiated cotrimoxazole preventive therapy (CPT) (518 [87.2%]) while taking anti-TB treatment. Seventy-three (13.6%) TB and HIV co-infected patients died before completing anti-TB treatment. Three-quarters (54 [74.4%]) of patients who died before completing anti-TB treatment were on ART, among them two patients who were on ART at least 3 months prior to commencing anti-TB. Also, the majority (64 [87.7%]) of TB and HIV co-infected patients were commenced on CPT prior to death. There was a bimodal density curve of death occurrence in those who did not commence ART and in those who did not commence CPT.ConclusionThis study established that TB and HIV co-infected patients had a TB mortality of 13.6%. A high mortality rate was observed during the first 3 months in those who did not take ART and during the second and the fifth month in those who did not commence CPT. Further study is needed to clarify this matter.

Comparative effectiveness of anti-viral drugs with dual activity for treating hepatitis B and HIV co-infected patients: a network meta-analysis

BackgroundThere are randomized trials assessing a variety of antiviral drugs for hepatitis B virus (HBV), but the relative effectiveness of these drugs in the treatment of patients co-infected with human immunodeficiency virus (HIV) remains unclear. The objectives of the current study were to estimate and rank the relative effectiveness of antiviral drugs for treating HBV and HIV co-infected patients.MethodsRandomized trials, assessing the efficacy of antiviral drugs for HBV and HIV co-infected patients were searched in health-related databases. The methodological quality of the included trials was evaluated using the Cochrane risk of bias tool. Main outcome in this meta-analysis study was the success of treatment by antivirals as determined by virologic response. We performed pairwise and network meta-analysis of these trials and assessed the quality of evidence using the GRADE approach.ResultsSeven randomized trials (329 participants) were included in this network meta-analysis study. A network geometry was formed with six treatment options including four antiviral drugs, adefovir (ADV), emtricitabine (FTC), lamivudine (LMV) and tenofovir disoproxil fumarate (TDF), combination treatment of TDF plus LMV, and placebo. The weighted percentage contributions of each comparison distributed fairly equally in the entire network of evidence. An assumption of consistency required for network meta-analysis was not violated (the global Wald test for inconsistency: Chi2(4) = 3.63, p = 0.46). The results of estimates showed no differences between the treatment regimens in terms of viral response for treating HBV and HIV co-infected patients, which spanned both benefit and harm (e.g. LMV vs TDF plus LMV: OR: 0.37, 95%CI: 0.06–2.41). Overall, the certainty of evidence was very low in all comparisons (e.g. LMV vs TDF plus LMV: 218 fewer per 1000,121 more to 602 fewer, very low certainty). Therefore, we remained uncertain to the true ranking of the antiviral treatments in HBV/ HIV co-infected patients.ConclusionsThe findings suggest that the evidence is insufficient to provide guidance to the relative effectiveness of currently available antiviral drugs with dual activity in treating co-infection of HBV/HIV. Well-designed, large clinical trials in this field to address other important outcomes from different epidemiological settings are recommended.

English

Provision of integrated care for human immunodeficiency virus (HIV) co-infected tuberculosis (TB) patients is challenging. Many persons with TB and HIV co-infection are not yet receiving anti-retroviral therapy (ART) and initiation of ART is not always timely. This study investigated ART uptake among HIV co-infected TB patients and its time of initiation in an urban primary health care facility in Ethiopia. A retrospective cohort study was conducted using routine program data. All adult HIV co-infected TB patients registered in a large TB-HIV clinic in Addis Ababa from September, 2008 to August, 2014 were included. Both descriptive and inferential statistics were used to summarize and analyse findings. A total of 993 TB patients were registered in the study period and included. HIV counselling and testing was offered to 738 (74.5%) and HIV testing was performed for 678 (68.3%) patients. Of those tested, 226 (33.3%) were HIV co-infected of whom 125 (57.6%) were started on ART. The median period from commencement of TB treatment to starting of ART was 41 days. ART initiation was delayed beyond the period advised in the National TB-HIV Guideline for 31 (27%) of HIV co-infected TB patients. For 109 (48.2%) of co-infected TB patients the ART status evaluation could not be done due to missing data. A considerable proportion of HIV co-infected TB patients did either not receive ART or started it later than recommended by national guidelines. For better outcomes to HIV co-infected TB patients, the actual implementation of national recommendations on when to start ART needs to be monitored closely. Key words: ART-uptake delay, TB-HIV, primary health facility.

Primary tubercular submandibular abscess: a rare presentation in two years old girl

Extra pulmonary tuberculosis (TB) continues to be a serious problem in developing countries. The prevalence of extra pulmonary tuberculosis (EPTB) is higher in immunocompromised, especially human immunodeficiency virus (HIV) co-infected patients. The most common site of extra pulmonary tuberculosis is lymph node followed by pleura. Lymph nodes are pivotal component of immune system and hence they are affected in various conditions like infections, autoimmune disorder, malignancy However, tubercular affliction of submandibular lymph node is not common. Only a few cases of tubercular submandibular abscess in immune-competent children have been reported in literature. Here we report a case of two-year old girl with non-healing multiple submandibular lymph node abscess presenting as a primary tuberculosis that proved diagnostically challenging. She responded favourably to a five drug anti-tubercular regimen.

Human pegivirus (HPgV) infection in Ghanaians co-infected with human immunodeficiency virus (HIV) and hepatitis B virus (HBV).

Human pegivirus (HPgV) is a positive single-stranded RNA virus in the Flaviviridae family. Phylogenetic analysis reveals the presence of multiple HPgV genotypes with distinct geographic locations. HPgV is of interest because of its potential beneficial impact on HIV disease progression. Despite this, the effects of HPgV in the context of other viral infections, such as hepatitis B virus (HBV), are poorly understood, and data from resource-limited settings are scarce. Therefore, we conducted a cross-sectional analysis of HPgV in HIV/HBV co-infected patients in Ghana. Sera from 100 HIV/HBV co-infected individuals were evaluated for HPgV RNA, and the genotype determined by sequencing the 5' untranslated region. HPgV RNA was detected in 27 samples (27%). Of these, 26 were genotyped successfully with 23 belonging to HPgV genotype 1 and 3 belonging to HPgV genotype 2. The presence of HPgV RNA had no statistically significant impact on CD4 cell count or HBV DNA titers in the HIV/HBV co-infected patients. However, there was a trend towards decreased HBV DNA levels in HPgV RNA-positive patients with CD4 cell count < 200 (p = 0.0626). HPgV co-infection is common in Ghana. The effect of HPgV on HIV or HBV disease among HIV/HBV co-infected patients was minimal. However, decreased HBV DNA levels in HPgV RNA-positive patients with low CD4 cell counts highlight the need for prospective studies of HPgV in HIV and hepatitis co-infected patients, especially in those with advanced HIV disease, to study further the effects of HPgV on liver disease.

Analysis of HBV basal core promoter/precore gene variability in patients with HBV drug resistance and HIV co-infection in Northwest Ethiopia.

BackgroundWe recently reported complex hepatitis B virus (HBV) drug resistant and concomitant vaccine escape hepatitis B surface antigen (HBsAg) variants during human immunodeficiency virus (HIV) co-infection and antiretroviral therapy (ART) exposure in Ethiopia. As a continuation of this report using the HBV positive sera from the same study participants, the current study further analyzed the HBV basal core promoter (BCP)/precore (PC) genes variability in patients with HBV drug resistance (at tyrosine-methionine-aspartate-aspartate (YMDD) reverse transcriptase (RT) motifs) and HIV co-infection in comparison with HBV mono-infected counterparts with no HBV drug resistant gene variants.Materials and methodsA total of 143 participants of HBV-HIV co-infected (n = 48), HBV mono-infected blood donors (n = 43) and chronic liver disease (CLD) patients (n = 52) were included in the study. The BCP/PC genome regions responsible for HBeAg expression from the EcoRI site (nucleotides 1653–1959) were sequenced and analyzed for the BCP/PC mutant variants.ResultsAmong the major mutant variants detected, double BCP mutations (A1762T/G1764A) (25.9%), Kozak sequences mutations (nt1809-1812) (51.7%) and the classical PC mutations such as A1814C/C1816T (15.4%), G1896A (25.2%) and G1862T (44.8%) were predominant mutant variants. The prevalence of the double BCP mutations was significantly lower in HIV co-infected patients (8.3%) compared with HBV mono-infected blood donors (32.6%) and CLD patients (36.5%). However, the Kozak sequences BCP mutations and the majority of PC mutations showed no significant differences among the study groups. Moreover, except for the overall BCP/PC mutant variants, co-prevalence rates of each major BCP/PC mutations and YMDDRT motif associated lamivudine (3TC)/entecavir (ETV) resistance mutations showed no significant differences when compared with the rates of BCP/PC mutations without YMDD RT motif drug resistance gene mutations. Unlike HIV co-infected group, no similar comparison made among HBV mono-infected blood donors and CLD patients since none of them developed the YMDD RT motif associated 3TC/ETV resistance mutations. However, HBV mono-infected blood donors and CLD patients who had no any drug resistance gene variants developed comparable G1862T (60.6% vs. 65.1%) and G1896A (24.2% vs. 11.6%) PC gene mutations.ConclusionNo correlation observed between the BCP/PC genome variability and the YMDD RT motif associated HBV drug resistance gene variants during HIV co-infection. Nevertheless, irrespective of HIV co-infection status, the higher records of the BCP/PC gene variability in this study setting indicate a high risk of potential HBeAg negative chronic HBV infection in Northwest Ethiopia.

Treatment rate for HCV in the direct-acting antivirals era in HIV co-infected patients: data from an Italian cohort.

New direct antiviral agents (DAA) are now effective in hepatitis C virus (HCV) infection; persons living with human immunodeficiency virus (HIV) (PLWH) were undertreated. Aim of this study was to describe the management of HCV treatment in a HIV/HCV cohort during a 16 years period. An electronic review of all HIV patients with >1 clinic check from the year 2000 was made. Demographic, virologic and treatment data were collected. From 2000 to 2015 a total of 2352 PLWH were enrolled; 776 (33%) resulted positive at HCV antibodies, and were mostly genotype 1 and 3. 279/579 (48.2%) were treated, and 170 (29.3% of total, 60.9% of treated) obtained a SVR. Treatment rate for HCV had a significant increase in the 2015 (20.6%, P<0.05 when compared with previous years). SVR rate was significantly improved in the 2015 (P<0.05 when compared with each single previous year). At univariate analysis among the different year group there were significant differences in term of HCV RNA positive patients (P<0.001), number of treated (total) and naïve patients (P<0.001 in each of cases), SVR rate (P<0.001), mortality rate (P=0.003). HCV-Ab positive patients with HCV-RNA not detectable (cured) increased during years. At 2015, 50.4% of the HCV-Ab positive patients resulted to be HCV-RNA negative. In the DAA's era a significant increase in the number of treatments was observed. SVR rate was significantly higher. Treatment rate still remains quite low. More than a half of our population of HCV co-infected patients results to be cured for HCV.

Immunomodulatory Therapy of Visceral Leishmaniasis in Human Immunodeficiency Virus-Coinfected Patients

Patients with visceral leishmaniasis (VL)–human immunodeficiency virus (HIV) coinfection experience increased drug toxicity and treatment failure rates compared to VL patients, with more frequent VL relapse and death. In the era of VL elimination strategies, HIV coinfection is progressively becoming a key challenge, because HIV-coinfected patients respond poorly to conventional VL treatment and play an important role in parasite transmission. With limited chemotherapeutic options and a paucity of novel anti-parasitic drugs, new interventions that target host immunity may offer an effective alternative. In this review, we first summarize current views on how VL immunopathology is significantly affected by HIV coinfection. We then review current clinical and promising preclinical immunomodulatory interventions in the field of VL and discuss how these may operate in the context of a concurrent HIV infection. Caveats are formulated as these interventions may unpredictably impact the delicate balance between boosting of beneficial VL-specific responses and deleterious immune activation/hyperinflammation, activation of latent provirus or increased HIV-susceptibility of target cells. Evidence is lacking to prioritize a target molecule and a more detailed account of the immunological status induced by the coinfection as well as surrogate markers of cure and protection are still required. We do, however, argue that virologically suppressed VL patients with a recovered immune system, in whom effective antiretroviral therapy alone is not able to restore protective immunity, can be considered a relevant target group for an immunomodulatory intervention. Finally, we provide perspectives on the translation of novel theories on synergistic immune cell cross-talk into an effective treatment strategy for VL–HIV-coinfected patients.

Treatment outcome of tuberculosis among Human Immunodeficiency Virus positive patients in Eastern Ethiopia: a retrospective study.

IntroductionTuberculosis is the leading cause of morbidity and mortality among people living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome worldwide. Although Human Immunodeficiency Virus related tuberculosis is both treatable and preventable, incidence rates continue to climb in developing countries where both infections are endemic. The aim of this study was to assess the treatment outcome of tuberculosis among Human Immunodeficiency Virus positive patients attending in three hospitals of Eastern Ethiopia.MethodsA retrospective clinical record review was conducted for 627 Tuberculosis and Human immunodeficiency virus co-infected patients registered from January 2008 to January 2014 cards were reviewed in three hospitals of tuberculosis clinics of Eastern Ethiopia from December 2015 to February 2016. The three hospitals were selected based on their high patient load of TB-HIV co infection and the presence of ART and TB units. Data on patient's details and tuberculosis treatment outcome were collected using standardized report format of National Tuberculosis and Leprosy Control Programme (NTLCP). The collected data were analyzed by Statistical Package for Social Sciences (SPSS) software Version 16.ResultsThe overall treatment success rate was 78.3%. Of the total TB-HIV co infected study participants, 17.9% cured, 60.4% treatment completed, 8.6% died, 0.6% failure, 1.8% defaulter and 10.7% transferred out. Those participants in the age groups of less than or equals to 18 years old (Adjusted Odds Ratio = 1.990, 95% Confidence Interval: 1.01, 3.350), extra pulmonary tuberculosis (Adjusted Odds Ratio = 1.51, 95% Confidence Interval = 1.12, 3.42), on antiretro viral therapy (Adjusted Odds Ratio = 1.54, 95% Confidence Interval = 1.252, 3.910) were more likely to have higher treatment outcome than each of the above variables counter parts.ConclusionThe rate of treatment success in this study was lower than recommended rate by World Health Organization. Thus this study recommends improving counseling during tuberculosis treatment, providing home visits and motivation of patients, improving defaulter tracing and health information dissemination in order to reduce treatment interruption.