Human Immunodeficiency Virus Infected Individuals Research Articles

Baseline Haematological Evaluation in Individuals Prior to Initiating Antiretroviral Therapy for HIV

Introduction: Human immunodeficiency virus (HIV) was discovered in 1983, while acquired immunodeficiency syndrome (AIDS) was first detected in 1981. Since then, it continues to be a public health problem. The phenomenon of HIV/AIDS is best viewed as a pandemic affecting almost all countries of the world. The first case of HIV/AIDS in Bangladesh was documented in 1989.This study was conducted to evaluate the baseline haematologicalcharacteristic in individuals prior to initiating antiretroviral therapy for HIV. Methods: This study was a cross sectional analytical study conducted among one hundred and fifty-four HIV positive patients attending at ART center, Bangabandhu Sheikh Mujib Medical University. Patients were included as per inclusion and exclusion criteria. Co-morbid conditions were excluded mostly by self-reporting and clinically relevant investigations. Result:The study revealed that HIV infected patients were predominantly middle-aged and young comprising > 70% of the patients with the mean age of the patients being 35.5 ± 9.5 years (range: 20-60 years). A male preponderance was observed in the study with a male-to-female ratio being 3:1. The majority (92.2%) of patients received first-line ART. The red cell indices like Hct, MCV, MCH, and MCHC were also low at the initiation of therapy but changed to normality after treatment. Conclusion: From the findings of the study, it can be concluded that HIV infected individuals are predominantly male, middle-aged, and young. The most common haematological abnormality is anaemia which is significantly reduced in percentage after a mean treatment period of nine and a half months with ART. Bangladesh J Medicine 2024; 35(1): 26-32

Prevalence and predictors of tuberculosis among HIV patients who completed isoniazid preventive therapy (IPT) at Reach out Mbuya community health initiative

Tuberculosis (TB) continues to be the leading cause of morbidity and mortality among human immunodeficiency virus (HIV) infected individuals in Sub Saharan Africa, including Uganda. Isoniazid prophylaxis therapy (IPT) is a major public health intervention to limit tuberculosis disease among people living with HIV. However, there is limited information about the influence of IPT on TB disease incidence and its associated risk factors among HIV positive patients in Uganda especially at Reach out-Mbuya community health initiative hence the study. A cross sectional study was conducted among HIV positive adult patients who completed a 6-months long daily treatment of Isoniazid preventive therapy. Sputum samples and urine samples were collected and analysed using Gene Xpert and lateral flow urine Lipoarabinomannan (LF-LAM) tests respectively for presence of Tuberculosis disease. Data analysis was performed using STATA (version 14). Bivariate and multivariate logistic regression were performed to assess the risk factors associated with tuberculosis among the study population and significance estimated at 95% confidence level. A total of 103 HIV positive adults was studied. The mean age of the participants was 42.1 (10.5) and median age was 43 (IQR = 16). The prevalence of tuberculosis disease among HIV positive adult patients who completed Isoniazid preventive therapy was 5.8% (6/103). Counselling, the only significant factor, reduced the likelihood of occurrence of TB disease among HIV patients on IPT treatment (aOR:0.028, P-value < 0.001). A low prevalence of TB disease was observed among HIV patients on IPT treatment. Counselling is a protective factor of TB disease among HIV patients on IPT treatment.

Mucormycosis in Human Immunodeficiency Virus-Infected Individuals: A Systematic Review of Case Reports.

Mucormycosis in human immunodeficiency virus (HIV) infection is uncommon; notably, many cases have additional predisposing factors. Whether mucormycosis differs in HIV-affected individuals with and without additional risk factors (e.g., neutropenia, diabetes mellitus, and transplantation) remains unclear. In this systematic review, we identified 94 cases of HIV and mucormycosis classifiable into three groups: (1) HIV with additional risk factors (n = 50), (2) intravenous drug users (IVDU, n = 24), and (3) no other risk factor (n = 19) for mucormycosis. The most common presentation in IVDU was renal (41.7%) and cerebral mucormycosis (39.2%), whereas rhino-orbital mucormycosis (ROM, 4.2%) was uncommon. In the other two groups, ROM was the most common presentation. Rhizopus was the most frequently isolated Mucorales; however, in IVDU, Lichtheimia was the most common. The overall mortality was 53% and not significantly different in the three groups. Mucormycosis in HIV-infected individuals is rare without additional risk factors or IVDU.

The prevalence of anemia among human immunodeficiency virus-infected individuals in East Africa: A systematic review and meta-analysis.

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients face several hematological abnormalities. Of these abnormalities, anemia is the most common one. Africa has a high prevalence of HIV/AIDS, especially in the East and South African region, which is heavily affected by the virus. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of anemia among patients with HIV/AIDS in East Africa. This systematic review and meta-analysis was conducted based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. PubMed, Google Scholar, Science Direct, Dove Press, Cochrane Online, and African journals online were searched systematically. The quality of the included studies was assessed by 2 independent reviewers using the Joanna Briggs Institute critical appraisal tools. Data were extracted into an Excel sheet and then exported to STATA version 11 for analysis. A random-effect model was fitted to estimate the pooled prevalence and Higgins I2 test statistics were done to test the heterogeneity of studies. Funnel plots analysis and Egger-weighted regression tests were done to detect publication bias. The pooled prevalence of anemia among HIV/AIDS patients in East Africa was 25.35% (95% CI: 20.69-30.03%). A subgroup analysis by highly active antiretroviral therapy (HAART) status showed that the prevalence of anemia among HAART naive HIV/AIDS patients was 39.11% (95% CI: 29.28-48.93%) whereas the prevalence among HAART experienced was 36.72% (95% CI: 31.22-42.22%). A subgroup analysis by the study population showed that the prevalence of anemia among adult HIV/AIDS patients was 34.48% (95% CI: 29.52-39.44%) whereas the pooled prevalence among children was 36.17% (95% CI: 26.68-45.65%). This systematic review and meta-analysis revealed that anemia is among the most common hematological abnormalities in HIV/AIDS patients in East Africa. It also underscored the importance of taking diagnostic, preventive, and therapeutic measures for the management of this abnormality.

Virological Failure and its Predictors among Human Immunodeficiency Virus Infected Individuals on Second Line Antiretroviral Treatment in North-East Ethiopia, 2021.

Acquired Immune Deficiency Syndrome (AIDS) becomes a manageable chronic disease due to the presence of effective prevention, diagnosis, treatment, and care accesses. Viral load cascade analyses are important to identify gaps in HIV/AIDS treatment and care for quality improvements OBJECTIVE: Time to Virological Failure and its Predictors among HIV Infected Individuals on Second Line Antiretroviral Treatment (SLART) in North-East Ethiopia, 2021 METHODS: Institution-based retrospective follow-up study was conducted on 474 HIV-infected individuals who were on SLART between September 2016 and April 2020. A universal sampling technique was used to recruit study participants. Data were entered by EpiData-3.3.1 and analyzed by STATA-14. Cox proportional hazard assumptions were checked to determine the effect of predictor variables on Virological Failure (VF). The study was conducted from February 01-April 30/ 2021 RESULT: The rate of Virological Failure (VF) in this study was 15.4% with an incidence rate of 4.93 per 100 person-years. As participants' age and duration of ART use increased by one year the hazards of VF was reduced by 2.9% (AHR: 0.971, 95%CI: 0.945, 0.995) and 10.6% (AHR: 0.894, 95%CI: 0.828, 0.963) respectively. The hazards of VF were twice higher among those who were on a non-protease inhibitor-based regimen. Individuals who had a history of Making Enhanced Adherence Counseling (EAC) sessions during SLART had three times more risk to develop VF (AHR:3.374, 95%CI:1.790, 6.361) CONCLUSION AND RECOMMENDATIONS: The rate of VF among SLART users was high. Keeping SLART users on PI-based regimens may improve virological outcomes in HIV care and treatment. Making EAC sessions effective in promoting better ART adherence might reduce VF. This article is protected by copyright. All rights reserved.

Association of Toll-Like Receptor 3 Polymorphisms with Kaposi's Sarcoma-Associated Herpesvirus Infection Among Human Immunodeficiency Virus-Infected Individuals in Xinjiang, China.

Toll-like receptors (TLRs) play a crucial role in the innate immune response to pathogens, and TLR3 could recognize and control the herpesvirus. We studied the effect of TLR3 polymorphisms on the risk of Kaposi's sarcoma-associated herpesvirus (KSHV) infection. A cross-sectional study was performed among human immunodeficiency virus (HIV)-infected individuals in Xinjiang, a KSHV-endemic region of China. The frequencies of nine single-nucleotide polymorphisms (SNPs) in TLR3 in 370 KSHV-infected patients and 558 controls, and their impact on plasma IFN-γ levels, were compared. The effect of TLR3 SNPs on the KSHV viral load in KSHV-infected subjects was also assessed. The minor allelic variant at rs13126816 was more common among KSHV-seronegative than KSHV-infected individuals. Two TLR3 SNPs (rs13126816 and rs3775291) showed a protective effect against KSHV infection (rs13126816: odds ratio [OR]dominant = 0.66, 95% confidence interval [CI]: 0.50-0.87; ORoverdominant = 0.65, 95% CI: 0.49-0.87; rs3775291: ORdominant = 0.76, 95% CI: 0.58-0.99; ORoverdominant = 0.75, 95% CI: 0.57-0.98). These associations were stronger in the Uyghur compared with the Han population. The haplotype, CGAC, significantly correlated with the risk of KSHV infection (OR = 0.72, p = 0.029). KSHV-infected individuals with homozygous rs13126816 AA genotypes had a lower KSHV viral load (aOR = 0.14; p = 0.038). However, no association was observed between TLR3 SNPs and plasma levels of IFN-γ. Genetic variants in TLR3 reduce the risk of KSHV infection and affect KSHV reactivation among HIV-infected individuals, especially in the Uyghur population.

Knowledge and awareness of HIV/AIDS among male prisoners in Kuwait

Background: Prisoners are considered as one of the high-risk populations for the transmission of human immunodeficiency virus (HIV) infection. Targeting this group is one of the strategies to reduce the incidence of acquired immune deficiency syndrome (AIDS) in the community. Subjects and Methods: A cross-sectional study was conducted among male inmates in Kuwait’s prison by administering three sets of questionnaires to assess the level of their knowledge and awareness about the mode of transmission of HIV/AIDS, their risky personal behavior that may lead to HIV infection, and the presence of any negative attitudes and stigmatization towards HIV infected individuals. Results: The study included 123 male inmates, with a mean ± SD age of 30.9 ± 8.4 years. Most participants had a good general knowledge about the mode of transmission of HIV/AIDS including sharing contaminated syringes, but with misconception regarding handshaking and kissing. On the other hand, risky personal behaviors such as having unprotected sex and increased number of extramarital relationships (66%), and the avoidance of the regular use of condoms (75%) was high. The younger age group (&lt; 35 years) had more extramarital relationships than those &gt; 35 years (71.4% Vs. 46.4%; p=0.016). There was a perceived attitude of stigmatization among inmates towards people living with HIV. Conclusions: This vulnerable group of prisoners, especially young adults need educational programs to improve knowledge about transmission of HIV, and to correct and change their risky personal behaviors to protect them and the community against HIV transmission

HBV and HCV Coinfection in Patients Living with HIV

Coinfection with hepatitis B virus (HBV) and hepatitis C virus (HCV) in human immunodeficiency virus (HIV) infected individuals results in increased hepatic complications. HBV and HIV viruses are transmitted by blood and unprotected sexual intercourse. People with HIV and HBV coinfection are at increased risk for liver-related morbidity and mortality. HCV-related liver injury progresses more rapidly among people coinfected with HIV. HCV coinfection may also affect the management of HIV infection. This review aims to go over the management of HIV-HCV and HIV-HBV coinfections.

The Influence of Saturated and Bilinear Incidence Functions on the Dynamical Behavior of HIV Model Using Galerkin Scheme Having a Polynomial of Order Two

Mathematical modelling has been extensively used to measure intervention strategies for the control of contagious conditions. Alignment between different models is pivotal for furnishing strong substantiation for policymakers because the differences in model features can impact their prognostications. Mathematical modelling has been widely used in order to better understand the transmission, treatment, and prevention of infectious diseases. Herein, we study the dynamics of a human immunodeficiency virus (HIV) infection model with four variables: S (t), I (t), C (t), and A (t) the susceptible individuals; HIV infected individuals (with no clinical symptoms of AIDS); HIV infected individuals (under ART with a viral load remaining low), and HIV infected individuals (with two different incidence functions (bilinear and saturated incidence functions). A novel numerical scheme called the continuous Galerkin-Petrov method is implemented for the solution of the model. The influence of different clinical parameters on the dynamical behavior of S (t), I (t), C (t) and A (t) is described and analyzed. All the results are depicted graphically. On the other hand, we explore the time-dependent movement of nanofluid in porous media on an extending sheet under the influence of thermal radiation, heat flux, hall impact, variable heat source, and nanomaterial. The flow is considered to be 2D, boundary layer, viscous, incompressible, laminar, and unsteady. Sufficient transformations turn governing connected PDEs into ODEs, which are solved using the proposed scheme. To justify the envisaged problem, a comparison of the current work with previous literature is presented.

A study on the safety and tolerability of antiretroviral drugs prescribed in ART center of a rural-based tertiary care hospital

Background: Human immunodeficiency virus (HIV) is a serious health problem worldwide. The mainstay treatment of HIV infected individuals is antiretroviral therapy (ART). Although ART is effective, it has its drawbacks as it is causes various adverse drug reactions (ADRs) which negatively affects patient compliance resulting in treatment failure. Various studies have been conducted in western population to study the adverse effects of ART, but such study in Eastern India is scanty. This study was conducted to fill the void and to help optimize treatment in this area. Aim and Objectives: The aim of the study was to find the incidence and type of ADRs among patients on antiretroviral drugs and to evaluate the severity assessment of the ADRs caused by them. Materials and Methods: Pre-structured case record form was used to collect information regarding demography, disease, treatment, etc., of 188 patients who came to the ART center after taking consent. ADRs were noted on the basis of patient complaints and changes diagnosed by the physician (if any) during routine visit. Descriptive statistical analysis was performed and inference drawn. Results: Most of the subjects followed Tenofovir-Lamivudine-Efavirenz regimen of whom 89% experienced at least one ADR, central nervous system (CNS) being the most affected. Followed by Zidovudine-Lamivudine-Nevirapine regimen of whom 96% presented with at least one ADR where gastrointestinal (GI) side effects were maximum. Common CNS side-effects were dizziness followed by insomnia. Common GI side effects was anorexia followed by nausea and vomiting. Most of them were mild in severity assessment scale. Conclusions: The study shows the ART regimens used by HIV patients and assess the ADRs caused by them. It helped to obtain information regarding demographic factors and disease pattern in this region. Further and more elaborate studies are needed to have proper insight and practical gains in this regard.

Fractures occurring in human immunodeficiency virus-infected individuals observed in coastal Karnataka: A series of 13 cases.

Fractures occurring in human immunodeficiency virus-infected individuals observed in coastal Karnataka: A series of 13 cases.

Surrogate Biomarkers of Disease Progression in Human Pegivirus Seropositive Human Immunodeficiency Virus-Infected Individuals.

Scientific observations indicate that an actively prevailing systemic condition could alleviate the pathology of another disease. Human pegivirus (HPgV), a highly ubiquitous flavivirus is believed to be associated with slow human immunodeficiency virus (HIV) disease progression, and has seldom been linked to hepatic pathology. In this study, we investigated whether HPgV seropositivity had any impact on surrogate markers of HIV disease progression in a cohort of HIV-infected HPgV seropositive (n = 28) and seronegative (n = 12) individuals who were prospectively evaluated for absolute CD4+ T cell counts, plasma viral load (PVL), liver enzymes, and plasma cytokine levels. The HIV PVL was relatively lower in HPgV seropositive than in HPgV seronegative HIV-infected subjects. Clinical markers of hepatic injury were significantly low among HPgV seropositive HIV-infected participants. HPgV seropositive individuals showed significantly higher levels of interleukin-7 (IL-7), and although not significant, the levels of IL-6 were lower among HPgV seropositive subjects. Spearman correlation analysis showed that the absolute CD4+T cell count was inversely correlated with HIV PVL. Exposure to HPgV appears to have a positive prognostic impact on the levels of surrogate biomarkers of HIV disease progression.

High prevalence of vitamin D deficiency in HIV-infected individuals in comparison with the general population across Punjab province, Pakistan

The status of vitamin D in individuals infected with human immunodeficiency virus (HIV), particularly in naïve as well as treated patients, has never been reported in the Pakistani population. A cross-sectional study was performed to measure vitamin D in individuals infected with HIV living in various districts of the Punjab, Pakistan. 1000 persons attending various treatment centers of the Punjab were screened for HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), and Syphilis. Total 398 patients met inclusion criteria and vitamin D level was measured in respective cases by using enzyme-linked immunosorbent assay (ELISA) technique. 232 samples from the healthy population were also included in present research. Demographic history and clinical parameters regarding HIV disease were evaluated. Comparison of variables was done to find out the link between vitamin D levels and characteristics of HIV infected persons and comparison to that of healthy individuals was performed. Among 398 HIV patients vitamin D deficiency and insufficiency was found among 15 % and 39 % while majority of the control participants had sufficient levels of vitamin D (78 %). Most of the HIV infected individuals were males (68.6 %) and had age between 24 and 47 years (67.8 %). A significant relationship was found for vitamin D level, lifestyle and CD4 count among HIV + ve non acquired immunodeficiency syndrome (AIDS) subjects (95 % CI; p < 0.001, p = 0.09). For HIV + ve AIDS patients vitamin D had a significant relationship with lifestyle along with HIV viral load and CD4 count. Hypovitaminosis D prevails among the HIV infected population of Punjab, Pakistan.

Effect of HIV status and antiretroviral treatment on treatment outcomes of tuberculosis patients in a rural primary healthcare clinic in South Africa.

Tuberculosis (TB) remains the leading cause of death among human immunodeficiency virus (HIV) infected individuals in South Africa. Despite the implementation of HIV/TB integration services at primary healthcare facility level, the effect of HIV on TB treatment outcomes has not been well investigated. To provide evidence base for TB treatment outcome improvement to meet End TB Strategy goal, we assessed the effect of HIV status on treatment outcomes of TB patients at a rural clinic in the Ugu Health District, South Africa. We reviewed medical records involving a cohort of 508 TB patients registered for treatment between 1 January 2013 and 31 December 2015 at rural public sector clinic in KwaZulu-Natal province, South Africa. Data were extracted from National TB Programme clinic cards and the TB case registers routinely maintained at study sites. The effect of HIV status on TB treatment outcomes was determined by using multinomial logistic regression. Estimates used were relative risk ratio (RRR) at 95% confidence intervals (95%CI). A total of 506 patients were included in the analysis. Majority of the patients (88%) were new TB cases, 70% had pulmonary TB and 59% were co-infected with HIV. Most of HIV positive patients were on antiretroviral therapy (ART) (90% (n = 268)). About 82% had successful treatment outcome (cured 39.1% (n = 198) and completed treatment (42.9% (n = 217)), 7% (n = 39) died 0.6% (n = 3) failed treatment, 3.9% (n = 20) defaulted treatment and the rest (6.6% (n = 33)) were transferred out of the facility. Furthermore, HIV positive patients had a higher mortality rate (9.67%) than HIV negative patients (2.91%)". Using completed treatment as reference, HIV positive patients not on ART relative to negative patients were more likely to have unsuccessful outcomes [RRR, 5.41; 95%CI, 2.11-13.86]. When compared between HIV status, HIV positive TB patients were more likely to have unsuccessful treatment outcome in rural primary care. Antiretroviral treatment seems to have had no effect on the likelihood of TB treatment success in rural primary care. The TB mortality rate in HIV positive patients, on the other hand, was higher than in HIV negative patients emphasizing the need for enhanced integrated management of HIV/TB in rural South Africa through active screening of TB among HIV positive individuals and early access to ART among HIV positive TB cases.

Bacterial Profile and their Antibiotic Resistance Pattern among HIV Patients Diagnosed with Pneumonia in Felege-Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia

Background: Bacterial pneumonia remains the major cause of morbidity and admission diagnosis among human immunodeficiency virus-infected individuals. In the study area, data about the bacterial profile of pneumonia and their antimicrobial resistance pattern among people living with human immunodeficiency virus is limited. Hence, this study was aimed to estimate the prevalence of bacterial pneumonia, antibiotic resistance patterns of isolated bacteria, and associated factors among HIV patients in Felege Hiwot Referral Hospital. Method: A Hospital-based cross-sectional study was conducted from February 15 to June 15, 2019. Sputum specimens were collected from 163 pneumonia presumptive HIV seropositive individuals. Data on socio-demographic characteristics and risk factors were also collected using a structured questionnaire. Blood, Chocolate, and MacConkey agar plates were used to grow the isolates. The isolated colonies were identified based on Gram Stain, colony morphology, hemolysis, and biochemical tests. The antimicrobial susceptibility test was performed using the modified Kirby-Bauer Disc Diffusion method. Descriptive and multivariate analyses were performed using SPSS version 23. P-value &lt; 0.05 was considered statistically significant. Result: Out of 163 sputum samples, 68 (41.7%) were culture positive for common bacterial infections. The predominant bacterial isolates were Klebsiella pneumoniae 19 (27.9%), and Staphylococcus aureus, 17 (25%). From multivariate analysis, age groups 18-29 (AOR = 5.4, 95 % CI: 1.26-23.35), age groups 30-39 (AOR = 3.8, 95% CI: 1.03 13.80), recent viral load greater than or equal to 150 copies/ml (AOR= 24.3, 95 % CI: 2.61-56.38), viral load less than 150 copies/ml (AOR= 5.1, 95% CI: 1.26-21.04), cigarette smoking (AOR=15.5, 95% CI: 1.61-48.59), and alcohol consumption (AOR=8.1, 95% CI: 2.76-23.51) were found to have statistically significant association with bacterial pneumonia. Out of the tested antibiotics, 46 (70.8%) were resistant to cotrimoxazole and P. aeruginosa were 100% resistant to gentamycin and ceftazidime. Overall, 77.9% of the isolates were MDR. Conclusion: The study showed a high prevalence of bacterial pneumonia and a high percentage of drug resistance including MDR in the study area. Therefore, we recommend that culture and antimicrobial susceptibility tests should be routinely performed for the selection of appropriate treatment.

Alterations in high-dimensional T-cell profile and gene signature of immune aging in HIV-infected older adults without viremia.

Alterations in the components of the immune system occur with aging. The introduction of combination antiretroviral therapy (ART) has dramatically improved life expectancy in human immunodeficiency virus (HIV) infected individuals by suppressing viral replication and increasing CD4+ T‐cell counts. Immunosenescence‐like changes, including the expansion of memory CD8+ T cells with senescent features, are reported in young HIV‐infected individuals who do not have clinically detectable viremia on ART. However, it is less known whether HIV infection affects the immunosenescent status in older HIV‐infected individuals. Here, we addressed this question in older HIV‐infected, HIV‐uninfected, and frail individuals (all groups age ≥65 years) by examining a set of aging‐associated genes in peripheral blood mononuclear cells (PBMCs) as well as by analyzing subsets of CD4+ and CD8+ T cells in depth using high‐dimensional CyTOF analysis. Older HIV‐infected individuals had increased expression of aging‐associated genes such as CX3CR1 in PBMCs which are related to IL‐7 receptor low effector memory (IL‐7Rαlow EM) CD8+ T cells, a cell population known to expand with age. The subsets of IL‐7Rαlow EM CD8+ T cells expressing senescent, cytotoxic, and inflammatory molecules, including CD57, perforin, and CX3CR1, as well as memory CD4+ T cells expressing CD161 and CXCR3, molecules associated with replication‐competent HIV‐1 harboring cells, were increased in older HIV‐infected individuals. Overall, older HIV‐infected individuals without detectable viremia on ART had augmented levels of age‐associated immune alterations in PBMCs, suggesting that HIV infection has a persistent impact on senescence in older HIV‐infected individuals despite the clinically controlled viremia.

Risk factors for subclinical atherosclerosis in HIV-infected patients in Burundi: A cross sectional study

Background and Aims : Several studies have demonstrated higher incidence, prevalence and progression of subclinical atherosclerosis in HIV infected individuals. Chronic disease of people living with human immunodeficiency virus (HIV) infection are now approaching those of the general population. Previous, in vitro studies shown that HIV causes arterial injuries resulting in inflammation and atherosclerosis but direct relationship between HIV infection clinical stages and lower extremity arterial disease (LEAD) remain controversial. No study assessed, with an accurate method, both the prevalence of LEAD and the influence of HIV severity on LEAD in HIV outpatients in Central Africa.Methods: A cross-sectional study was conducted among 1250 HIV-infected outpatients in Burundi. Inclusion criteria were as follows: age ≥ 20 years, positive HIV status, and currently receiving ART. Clinical data were extracted from Centre records. Personal information and details of PAD-related symptoms were obtained through face-to-face interviews. All patients underwent ankle-brachial index (ABI) measurement and LEAD was diagnosed by ABI≤0.9.Results: The prevalence of LEAD was 14.72 % (CI 95%: 13.2-22.1). The mean age was 42, 8±7, 4 years. On multivariable analysis, factors associated with LEAD were diabetes (OR= 1.7; 95% CI: 1.09–2.79), obesity (OR=2.5, 95% CI: 1.27–5.02) and stage IV HIV clinical infection (OR=4.7, 95% CI: 2.29–9.85).Conclusions: This is the first study performed on a large HIV population in Central Africa, reporting high LEAD prevalence. It underlines the influence of HIV infection on peripheral atherosclerosis at latest clinical stage and the need for LEAD screening in HIV-infected patients. Background and Aims : Several studies have demonstrated higher incidence, prevalence and progression of subclinical atherosclerosis in HIV infected individuals. Chronic disease of people living with human immunodeficiency virus (HIV) infection are now approaching those of the general population. Previous, in vitro studies shown that HIV causes arterial injuries resulting in inflammation and atherosclerosis but direct relationship between HIV infection clinical stages and lower extremity arterial disease (LEAD) remain controversial. No study assessed, with an accurate method, both the prevalence of LEAD and the influence of HIV severity on LEAD in HIV outpatients in Central Africa. Methods: A cross-sectional study was conducted among 1250 HIV-infected outpatients in Burundi. Inclusion criteria were as follows: age ≥ 20 years, positive HIV status, and currently receiving ART. Clinical data were extracted from Centre records. Personal information and details of PAD-related symptoms were obtained through face-to-face interviews. All patients underwent ankle-brachial index (ABI) measurement and LEAD was diagnosed by ABI≤0.9. Results: The prevalence of LEAD was 14.72 % (CI 95%: 13.2-22.1). The mean age was 42, 8±7, 4 years. On multivariable analysis, factors associated with LEAD were diabetes (OR= 1.7; 95% CI: 1.09–2.79), obesity (OR=2.5, 95% CI: 1.27–5.02) and stage IV HIV clinical infection (OR=4.7, 95% CI: 2.29–9.85). Conclusions: This is the first study performed on a large HIV population in Central Africa, reporting high LEAD prevalence. It underlines the influence of HIV infection on peripheral atherosclerosis at latest clinical stage and the need for LEAD screening in HIV-infected patients.

Clinical features and 18F-FDG PET/CT for distinguishing of malignant lymphoma from inflammatory lymphadenopathy in HIV-infected patients

BackgroundIt is vital to distinguish between inflammatory and malignant lymphadenopathy in human immunodeficiency virus (HIV) infected individuals. The purpose of our study was to differentiate the variations in the clinical characteristics of HIV patients, and apply 18F-FDG PET/CT parameters for distinguishing of malignant lymphoma and inflammatory lymphadenopathy in such patients.MethodsThis retrospective cross-sectional study included 59 consecutive HIV-infected patients who underwent whole-body 18F-FDG PET/CT. Of these patients, 37 had biopsy-proven HIV-associated lymphoma, and 22 with HIV-associated inflammatory lymphadenopathy were used as controls. The determined parameters were the maximum of standard uptake value (SUVmax), SUVmax of only lymph nodes (SUVLN), the most FDG-avid lesion-to-liver SUVmax ratio (SURmax), laboratory examinations and demographics. The optimal cut-off of 18F-FDG PET/CT value was analyzed by receiver operating characteristic curve (ROC).ResultsConsidering the clinical records, the Karnofsky Performance Status (KPS) scores in patients with inflammatory lymphadenopathy were obviously higher than those in patients with malignant lymphoma (P = 0.015), whereas lymphocyte counts and lactate dehydrogenase (LDH) were obviously lower (P = 0.014 and 0.010, respectively). For the 18F-FDG PET/CT imaging, extra-lymphatic lesions, especially digestive tract and Waldeyer’s ring, occurred more frequently in malignant lymphoma than inflammatory lymphadenopathy. Furthermore, the SURmax and SUVLN in malignant lymphoma were markedly higher than those in inflammatory lymphadenopathy (P = 0.000 and 0.000, respectively). The cut-off point of 3.1 for SURmax had higher specificity (91.9%) and relatively reasonable sensitivity (68.2%) and the cut-off point of 8.0 for the SUVLN had high specificity (89.2%) and relatively reasonable sensitivity (63.6%).ConclusionOur study identified the distinctive characteristics of the clinical manifestations, the SURmax, SUVLN and detectability of extra-lymphatic lesions on 18F-FDG PET, and thus provides a new basis for distinguishing of malignant lymphoma from inflammatory lymphadenopathy in HIV-infected patients.

HIV/AIDS Associated Lymphoma: Review.

Lymphoma is one of the hematologic malignancies that occur at a higher rate in human immunodeficiency virus-infected individuals. It is one of the most frequent neoplastic causes of death in those individuals. Non-Hodgkin’s lymphoma and Hodgkin’s lymphomas are acquired immunodeficiency syndrome defining lymphoma and non-acquired immunodeficiency syndrome defining lymphoma, respectively. Non-Hodgkin’s lymphoma is the most common type of lymphoma in human immunodeficiency virus-positive people. The lymphoma that develops in patients infected with the human immunodeficiency virus/acquired immunodeficiency syndrome is heterogeneous in terms of morphology, pathogenesis pathways, and cellular derivation. A narrative review was conducted on the basis of relevant literature on the current topic to summarize the current epidemiology, pathogenesis, laboratory diagnosis, and treatment of lymphoma in human immunodeficiency virus-infected patients. The finding showed that although the incidence of non-Hodgkin’s lymphoma has decreased after the advent of highly active antiretroviral therapy, it has remained higher in human immunodeficiency virus-infected people than in the general population. On the other hand, the incidence of Hodgkin’s lymphoma has increased after the introduction of highly active antiretroviral therapy. Therefore, it is recommended that people living with human immunodeficiency virus/ acquired immunodeficiency syndrome be screened for the development of lymphoma to increase their survival time and quality of life, and further research is required regarding the pathogenesis, treatment, and laboratory diagnosis of human immunodeficiency virus/ acquired immunodeficiency syndrome-associated lymphoma.

Molecular epidemiology of hepatitis B virus among HIV co-infected and mono-infected cohorts in Northwest Ethiopia

BackgroundHepatitis B virus (HBV) infection is a particular concern in human immunodeficiency virus (HIV) infected individuals. In Ethiopia, detailed clinical and virological descriptions of HBV prevailing during HIV co-infection and symptomatic liver disease patients are lacking. The aim of this study was to investigate HBV virological characteristics from Ethiopian HBV/HIV co-infected and HBV mono-infected individuals.MethodsA total of 4105 sera from HIV positive individuals, liver disease patients, and blood donors were screened serologically for HBV. The overlapping polymerase/surface genome region of HBV from 180 infected individuals was extracted, amplified, and sequenced for genotypic analysis.ResultsThe HBsAg seroprevalence was detected 43% in liver disease patients, 8.4% in blood donors, and 6.7% in HIV/HBV co-infected individuals. The occult HBV prevalence was 3.7% in HIV/HBV co-infected individuals and 2.8% in blood donors with an overall prevalence rate of 3.4%. A phylogenetic analysis showed three HBV genotypes; A (61.1%), D (38.3%) and E (0.6%). Genotype A belongs to subtypes A1 (99.1%) and A9 (0.9%), but genotype D showed heterogeneous subtypes; D2 (63.8%) followed by D4 (21.7%), D1 (8.7%), D3 (4.3%), and D10 (1.4%).ConclusionsThe HIV/HBV co-infected individuals and blood donors showed lower HBsAg seroprevalence compared to liver diseases patients. Occult HBV prevalence showed no difference between HIV/HBV co-infected and blood donor groups. This study demonstrated predominance distribution of HBV subtypes A1 and D2 in northwest Ethiopia. The observed virological characteristics could contribute for evidence-based management of viral hepatitis in Ethiopia where antiretroviral therapy guidelines do not cater for viral hepatitis screening during HIV co-infection.