Human Immunodeficiency Virus Infected Patients Research Articles

Symptomatic human immunodeficiency virus infection is associated with advanced presentation and perioperative mortality in patients undergoing surgery for peripheral arterial disease

ObjectivePrior studies have demonstrated an increased risk of developing cardiovascular and peripheral arterial disease (PAD) in patients with human immunodeficiency virus (HIV). However, the effect of chronic HIV infection in patients with preexisting PAD and requiring vascular intervention is unclear. In the present study, we assessed the differences in clinical presentation and perioperative outcomes for patients with PAD who had undergone revascularization or amputation with and without HIV infection. MethodsInternational Classification of Diseases, 9th and 10th Revisions, Clinical Modification, codes were used to identify patients with a prior diagnosis of PAD who had undergone lower extremity revascularization or amputation in the National Inpatient Sample (2003-2017). From this group, the patients were divided for analysis into those with and without HIV infection. Of the patients with HIV infection (PWHs), we identified additional subsets of patients: those with any prior or current diagnosis of an HIV-related illness, including acquired immunodeficiency syndrome, designated as symptomatic HIV, and those without such a diagnosis, designated as asymptomatic HIV infection. Propensity score matching was performed to create matched cohorts. Population-based comparative analyses were performed of the clinical characteristics of the HIV-infected and HIV-uninfected groups. Univariate and multivariate logistic regression analyses of the perioperative in-hospital outcomes were performed on the matched cohorts. ResultsA total of 224,912 patients aged 18 to 85 years were identified who had been admitted with an established diagnosis of PAD and had undergone a lower extremity procedure. Of these patients, 1264 (0.56%) also had a diagnosis of HIV infection. Symptomatic PWHs were more likely to present with critical limb ischemia than were the HIV-uninfected patients or asymptomatic PWHs (66.2% vs 46.3% and 43.6%; P < .01). However, both asymptomatic and symptomatic PWHs were more likely to have required minor (7.5% and 6.7% vs 2.6%; P < .01) and major (12.9% and 27.4% vs 7.0%; P < .01) amputations than were matched HIV-uninfected controls. Although adjusted multivariate logistic regression analysis demonstrated symptomatic HIV infection to be a significant, independent predictor of in-hospital mortality (odds ratio, 2.46; 95% confidence interval, 1.37-4.40; P = .003), the perioperative mortality for the asymptomatic PWH was comparable to that of matched HIV-uninfected controls. ConclusionsSymptomatic PWHs, including patients living with acquired immunodeficiency syndrome, who had required a PAD-related procedure had presented with more advanced vascular disease and were most at risk of early perioperative mortality. However, the presentation and mortality between asymptomatic PWHs with well-controlled disease and HIV-uninfected patients were comparable. All PWHs with PAD were more likely to undergo lower extremity amputations than were HIV-uninfected matched controls. Asymptomatic, well-controlled HIV infection should not be a contraindication to elective PAD-related procedures because the mortality was similar to that of HIV-uninfected controls. However, the limb salvage rates might be lower for all PWHs with PAD, regardless of HIV disease severity. Taken together, these findings can improve perioperative risk stratification and surgical management of PAD in this high-risk population.

SPONTANEOUS TENSION PNEUMOMEDIASTINUM: MANAGEMENT IN PNEUMOCYSTIS JIROVECI PNEUMONIA

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Spontaneous secondary pneumothorax has been reported in up to 35% of patients with Pneumocystis jirovecii (PCJ) pneumonia with human immunodeficiency virus (HIV), however, associated with bilateral pneumothorax and pneumomediastinum is a rare life-threatening condition. We present an interesting case of non-surgical management of spontaneous bilateral pneumothorax with tension pneumomediastinum in an immunocompromised individual with mediastinal drain and large-bore chest tube at the bedside with significant improvement in symptoms and hemodynamic improvement. CASE PRESENTATION: 54 years old non-compliant with his medicines with a history of HIV, type II diabetes mellitus came with complaints of dyspnea on exertion, non-productive cough for 2-3 weeks. On admission, he was afebrile, tachypneic, tachycardiac with bilateral coarse breath sounds on physical exam. Chest x-ray on admission showed bilateral multifocal opacities without any pleural effusion or pneumothorax and initial laboratory results were unremarkable. He developed spontaneous subcutaneous emphysema with crepitus extending up to his neck and face three days into hospitalization. Computed Tomography (CT) chest showed bilateral ground-glass opacities, bilateral pneumothorax, and extensive pneumomediastinum along the neck with mass effect on the heart. Initially, bilateral chest tubes were placed with improvement in pneumothoraces but persistent air leaks. One week later, he had worsening pneumomediastinum with acute hypoxic respiratory failure and obstructive shock requiring mechanical ventilation. An emergent 8 Fr mediastinal drain was placed by the ICU team at the bedside under fluoroscopy guidance with improvement in his hemodynamic status. Bronchoscopy with bronchoalveolar lavage showed PCJ DNA on PCR. His symptoms resolved over the course of hospitalization and he was discharged home on room air after a prolonged hospitalization on Biktarvy® and trimethoprim-sulfamethoxazole. DISCUSSION: PCJ pneumonia should be considered as a cause of pulmonary infection in HIV patients, subcutaneous emphysema leading to pneumothorax and pneumomediastinum has been reported with high mortality rates. Spontaneous pneumothorax develops secondary to cyst or bleb rupture due to PCJ pneumonia. Spontaneous pneumomediastinum may occur due to an abrupt increase in the trans-alveolar pressure gradient due to infections, trauma, violent coughing, or can be iatrogenic; however, tension pneumomediastinum is extremely rare. In this case, urgent treatment of pneumomediastinum at the bedside with early treatment initiation for PCP without BAL results was a life-saving measure. CONCLUSIONS: Early recognition of symptoms in immunocompromised individuals, point-of-care ultrasound, and bedside procedures in an emergent setting in non-surgical candidates in the ICU are life-saving measures with prompt anti-microbial therapy for successful treatment. REFERENCE #1: Park YK, Jung HC, Kim SY, et al. Spontaneous Pneumomediastinum, Pneumopericardium, and Pneumothorax with Respiratory Failure in a Patient with AIDS and Pneumocystis jirovecii Pneumonia. Infect Chemother. 2014;46(3):204-208. doi:10.3947/ic.2014.46.3.204 REFERENCE #2: Yee D, Fu D, Hui C, Dharmadhikari N, Carino G. A Rare Case of 4 Ps: Bilateral Pneumothoraces and Pneumomediastinum in Pneumocystis Pneumonia. R I Med J (2013). 2020 Jun 1;103(5):52-54. PMID: 32481782 REFERENCE #3: Saleem N, Parveen S, Odigwe C, Iroegbu N. Pneumomediastinum, pneumorrhachis, and subcutaneous emphysema in Pneumocystis jiroveci pneumonia in AIDS. Proc (Bayl Univ Med Cent). 2016;29(2):188-190. doi:10.1080/08998280.2016.11929412 DISCLOSURES: No relevant relationships by Mahnoor Mir, source=Web Response No relevant relationships by Jay Peters, source=Web Response No relevant relationships by Jorge Villalpando, source=Web Response

The Prevalence of Drug–Drug Interactions with Antiretroviral Therapy in Human Immunodeficiency Virus–Infected Patients in the Intensive Care Unit

Background: Persons living with human immunodeficiency virus (HIV) (PWH) on antiretroviral therapy (ART) are frequently admitted to the intensive care unit (ICU). Persons living with HIV on ART may be at higher risk for potential drug–drug interactions (pDDIs) due to polypharmacy in the ICU. We determined the prevalence of pDDI with ART in critically ill PWH. Objectives: The primary outcome was prevalence of pDDI between ART and ICU medications. Secondary outcomes included pDDI per ICU admission, pDDI severity, ICU, and hospital length of stay (LOS). Methods: A single-center, retrospective cohort evaluating PWH ≥ 18 years old admitted to the ICU for > 24 hours who received ART during ICU admission, between January 2013 and 2015 at a tertiary care hospital in the United States. Each ICU admission was counted as a separate encounter. Medication databases and chart review were used to identify pDDI. Results: We included 77 PWH encounters; mean age was 55 ± 9 years and 65% were male. We identified 208 pDDIs among 53/77 (68.8%), with a mean 4 ± 2 pDDI per ICU admission. Antipsychotics (20%), analgesics (20%), and anti-lipemics (11%) were the most common ICU medications with ART-related pDDI. Of the pDDI, 64% were major, 24% moderate, and 12% contraindicated. Median ICU and hospital LOS were 4 days (IQR: 3–5) and 11 days (IQR: 7–31), respectively. Conclusion: Most PWH had at least one pDDI during ICU admission. Collaborations among pharmacists, intensivists, and infectious disease/HIV specialists to develop effective, actionable strategies, such as electronic health record alerts, could reduce pDDIs for PWH on ART in the ICU.

Study of the specific toxic effects of the substance 1-[2-(2-benzoylphenoxy)ethyl]-6-methyluracil, the original non-nucleoside inhibitor of human immunodeficiency virus type 1 (Retroviridae; Orthoretrovirinae; Lentivirus: Human immunodeficiency virus 1) reverse transcriptase

Combination antiretroviral therapy is currently the main component of treatment for human immunodeficiency virus (HIV) infected patients. At the same time, the high mutational potential of the virus and the frequency of side effects of existing drugs dictate the need for the development and preclinical study of new, more effective and safer compounds.The aim of the study is to evaluate the specific types of toxicity of a new non-nucleoside inhibitor of human immunodeficiency virus type 1 (HIV-1) reverse transcriptase (RNA-dependent DNA revertase) (NNRTI) based on the substance 1-[2-(2-benzoylphenoxy)ethyl]-6-methyluracil, a benzophenone derivative. The study investigated reproductive toxicity, embryotoxicity, immunotoxicity, genotoxic (in micronucleus test in and comet assay) and allergenic properties of the test itemcompound. It was tested on three species of animals in two doses: the estimated therapeutic dose (1 TD) and its tenfold equivalent (10 TD). Taking into account the metabolic coefficients, the doses for rats (Rattus) were 9 and 90 mg/kg, for mice (Mus musculus), 21 and 210 mg/kg, and for guinea pigs (Cavia porcellus), 8 and 80 mg/kg, respectively. According to the obtained results, a favorable safety profile of the tested compound was established. Negative effects on the immune system, reproductive function, the body of pregnant animals and the fetus were not observed, as well as the compound did not have genotoxic and allergenic properties. These data allows to consider the studied compound as a promising therapeutic candidate for the treatment of HIV-1 infection.

The development of autoverification system of lymphocyte subset assays on the flow cytometry platform.

Peripheral blood lymphocyte subsets are important parameters for monitoring immune status; however, lymphocyte subset detection is time-consuming and error-prone. This study aimed to explore a highly efficient and clinically useful autoverification system for lymphocyte subset assays performed on the flow cytometry platform. A total of 94,402 lymphocyte subset test results were collected. To establish the limited-range rules, 80,427 results were first used (69,135T lymphocyte subset tests and 11,292 NK, B, T lymphocyte tests), of which 15,000T lymphocyte subset tests from human immunodeficiency virus (HIV) infected patients were used to set customized limited-range rules for HIV infected patients. Subsequently, 13,975 results were used for historical data validation and online test validation. Three key autoverification rules were established, including limited-range, delta-check, and logical rules. Guidelines for addressing the issues that trigger these rules were summarized. The historical data during the validation phase showed that the total autoverification passing rate of lymphocyte subset assays was 69.65% (6,941/9,966), with a 67.93% (5,268/7,755) passing rate for T lymphocyte subset tests and 75.67% (1,673/2,211) for NK, B, T lymphocyte tests. For online test validation, the total autoverification passing rate was 75.26% (3,017/4,009), with 73.23% (2,191/2,992) for the T lymphocyte subset test and 81.22% (826/1,017) for the NK, B, T lymphocyte test. The turnaround time (TAT) was reduced from 228 to 167min using the autoverification system. The autoverification system based on the laboratory information system for lymphocyte subset assays reduced TAT and the number of error reports and helped in the identification of abnormal cell populations that may offer clues for clinical interventions.

Cytomegalovirus Encephalitis with Decreased Vision in Immunocompromised Patients Treated with Valganciclovir: Case Report

Introduction: Cytomegalovirus (CMV) is a significant cause of morbidity and mortality in patients with Acquired Immune Deficiency Syndrome (AIDS). Almost all Human Immunodeficiency Virus (HIV) infected patients develop CMV rapidly with manifestation in the central nervous system. Most CMV encephalitis is preceded by the presence of CMV in other places. Therefore, immediate therapy will be more effective and the delay in therapy can be detrimental. Case: A 40-year-old man with the major complaint of vision decrease in both eyes for 3 months claimed that he felt worse after 7 days, accompanied by headache and fever. This patient was diagnosed with HIV 2 years ago. The examination obtained GCS 456, negative meningeal sign, headache with NRS 7. The visual acuity of the right eye was negative light perception and in the left eye of vision 1/300. The patient experienced clinical improvement after oral Valganciclovir therapy with a dose of 2x450 mg. Conclusion: CMV encephalitis must be considered to diagnose earlier in HIV patients with complaints of decreased vision. With valganciclovir 2x450 mg tablets improve reduction of headache scale NRS from 7 to 2, increasing left eye vision from 1/300 to 6/60. Keywords: Encephalitis CMV, HIV, Valganciclovir.

P-2 HEPATIC STEATOSIS AMONG PEOPLE LIVING WITH HIV IN SOUTHERN BRAZIL: PREVALENCE AND RISK FACTORS

Chronic liver disease is an important cause of morbidity and mortality among people living with human immunodeficiency virus (HIV) and is frequently related to non-alcoholic fatty liver disease (NAFLD). The objective is to estimate the prevalence and risk factors of hepatic steatosis among consecutive patients with stable HIV infection on antiretroviral therapy (ART). Also, the use of transient elastography (TE) as a mean to identify a subgroup at risk for non-alcoholic steatohepatitis (NASH) and/or liver fibrosis. HIV infected patients were enrolled between August2016 and February2017. Inclusion criteria: ≥18 years with undetectable HIV viral load. Exclusion criteria: pregnancy; alcohol intake ≥20 g/day and co-infection B or C viruses. Patients underwent ultrasound (US) to diagnose liver steatosis. Significant fibrosis (≥F2) was estimated if at least one of the following were present: APRI > 1.0, FIB4 > 3 and/or liver stiffness ≥7.1kPa. Subjects with TE ≥ 7.1kPa were proposed a liver biopsy and NAFLD Scoring System (NAS) ≥ 3 was considered as diagnosis of NASH. A total of 98 patients were included. Liver steatosis was diagnosed in 31 patients (31.6%) and was independently associated with male gender, BMI, ALT and total bilirubin levels. The prevalence of significant fibrosis assessed by TE, APRI and FIB4 was 26.9%, 6.4% and 3.2%, respectively. Seven patients had a TE result ≥7.1kPa. NASH was found in 5 (83.3%). Among HIV infected patients undergoing ART, almost one third have NAFLD. Neither TE, APRI or FIB4 were able to act as surrogates for significant liver fibrosis. Nevertheless, TE ≥ 7.1kPa was able to accurately select a subgroup of patients at risk for NASH.

Cross Sectional Data on Profile of Coronary Artery Disease in Human Immunodeficiency Virus Infection Patients in a Tertiary Care Hospital of Central India

Background: Human immunodeficiency virus infection leads to a variety of Cardiovascular manifestations. Pericardial effusion, systemic hypertension, dilated cardiomyopathy, coronary artery disease, pulmonary hypertension, primary as well as secondary cardiac tumours etc are seen in about 30% of patients and the incidence has increased with improved longevity. Coronary artery disease ranging from subclinical atherosclerosis to coronary plaque rupture causing acute coronary syndrome have been documented. The main underlying pathophysiological process is a state of perennial inflammation which leads to initiation and acceleration of coronary atherosclerosis. Objective: To study the coronary angiographic profile in HIV patients. Methodology: HIV patients undergoing coronary angiography were assessed clinically, biochemically and finally by coronary angiography to see the coronary pathoanatomy. Results: Of the 37 HIV patients studied between Jan to Dec 2019, the mean age was 47 years.(19-66 years). Two thirds were males; most common traditional risk factor was dyslipidemia followed by hypertension. Most patients were already on ART and the CD 4 counts ranged from 67-366cells/cumm. Anterior wall MI and unstable angina were the most common clinical presentations. Coronary angiography revealed diffuse disease (both insignificant and significant) of the left anterior descending artery as the most common pattern of angiographic involvement. Conclusion: Coronary artery disease both subclinical and syndromic occurs with increased frequency in HIV patients. The dominant angiographic presentation correlates with the clinical presentation and in our study, left anterior descending artery was more frequently diseased as compared to other coronaries. The most common coronary angiographic pattern was the presence of ectasia and diffuse disease. Keywords: Human immunodeficiency virus, cardiovascular manifestations, coronary artery disease, coronary angiography.

FACTORS INFLUENCING CLINICAL MANAGEMENT OF CRYPTOCOCCAL MENINGITIS AMONG HEALTH CARE PROVIDERS AT TWO REFERRAL HOSPITALS IN KISUMU COUNTY, KENYA

Purpose: Cryptococcal meningitis is one of the most common and lethal opportunistic infections among human immune virus infected clients/patients before initiation of antiretroviral therapy. It is majorly associated to morbidity and early mortality among human immunodeficiency virus infected patients in resource limited countries. The main objective of this study was to investigate the factors influencing clinical management of cryptococcal meningitis in adults among health care providers at two referral hospitals in Kisumu County, Kenya.&#x0D; Methodology: A cross-sectional study using quantitative approach was used targeting 119 health care providers. Collection of data was through pretested self- administered questionnaires to examine factors influencing clinical management of cryptococcal meningitis. Data obtained was analyzed using the statistical package for social science version 25. Descriptive analysis was done using frequencies, percentages and means. Inferential analysis was conducted using bivariate logistic regression to determine relationships among the variables, p-values of at or below 0.05 were considered statistically significant.&#x0D; Results: The major factor associated positively with clinical management of cryptococcal meningitis was the acknowledgement by the health care providers that the world health organization guidelines lead to a better patient outcome (97%, n=113) and inadequate supplies and resources to facilitate management (78%, n=90) was the major factor associated negatively. Health care providers with an experience of five years or less were 40% more likely to agree that the factors were influencing clinical management of cryptococcal meningitis in contrast to those with an experience of six years or more (OR: 0.6; 95%CI: 0.1 – 0.74; p=0.04).&#x0D; Unique contribution to theory, practice and policy: The clinical management of cryptococcal meningitis in adults in the study area is majorly negatively influenced by inadequate supplies and resources to facilitate the process of management. The study recommends that the policy makers in the County government of Kisumu and the two hospital management teams need to scale up a timely and constant provision of adequate resources, facilities and supplies, which will promote effective clinical management of cryptococcal meningitis in the study area

A Case Report on Stavudine Induced Lipodystrophy

Abstract: Drug induced adverse drug reactions are more common in long term therapy particularly in immune compromised patients. Some of the drugs causes Redistribution of body fat (Lipodystrophy) in Human Immunodeficiency Virus (HIV) infected patients and loss of body fat (Lipoatrophy). Stavudine is the one of the first line regimens drugs used for HIV infection belongs to the category of Nucleoside reverse transcriptase enzyme inhibitor (NRTIs). In the present case, we have reported the stavudine induced severe Lipodystrophy (Lipoma). A patient visited the hospital with the symptoms of lump on back of neck as, she received Stavudine fixed dose combination (SLN) as a drug for her diagnosis of HIV for past seven years. After clear examination Lipodystrophy (Lipoma) was confirmed and suspected with the cause due to stavudine fixed dose regimen. The drug was stopped and the patient was opted to surgery for permanent cure. The patient was recovered from her condition and other antiretroviral drugs were recommended for her treatment. Key words: Antiretroviral therapy, Adverse drug reaction, Lipodystrophy, HIV, Lipoatrophy.

AIDS-defining opportunistic illnesses in Qatar, 2000–2016: a cohort study

Background: Human immunodeficiency virus (HIV) infection remains a major health problem since discovery of the virus in 1981 Globally, since the introduction of antiretroviral therapy in 1996, acquired immunodeficiency syndrome (AIDS) related deaths fell by more than 25% between 2005 and 2011. HIV related opportunistic illnesses (OIs) are less common, especially with the use of prophylaxis. This study aims to assess the incidence of HIV infection and related OIs in Qatar over a 17-year period. Methods: This is a retrospective cohort study of all HIV infected patients registered in Qatar from 2000-2016. Incidence of HIV infection and related OIs were calculated per 100,000 population. Demographic and clinical characteristics were compared between two groups of patients with and without OIs. Results: In 167 cases with HIV infection, 54 (32.3%) had OIs. The average incidence rate of HIV infection over 16 years is 0.69 per 100,000 population, and the incidence rate for OIs is 0.27 per 100,000 population (Figure 1). The most common OIs is pneumocystis jirovecii pneumonia (PCP), seen in 25% of cases, followed by cytomegalovirus (CMV) retinitis with 7.2%, tuberculosis 5.4%, toxoplasmosis 4.2%, and less than 2% for Kaposi sarcoma and cryptococcal infection. The treatment outcome of cases with OIs was: cure in 59.3%, failure in 3.7%. Mortality within 3 months of OIs was 3.7%, whereas 33.4% accounted for loss to follow up after starting the treatment due to patients leaving the country. Most patients in both groups were young males. The CD4 lymphocyte count and percentage (CD4%), CD4/CD8 ratio and viral load were statistically significant risk factors in cases with OIs (p &lt; 0.05). Presence of comorbidities was lower in patients with OIs (p = 0.032). Conclusion: Qatar has a low prevalence rate for HIV infection and related opportunistic illness. Early diagnosis and use of antiretroviral therapy are important measures to decrease the rate of opportunistic illness.

Effectiveness of Highly Active Anti-retroviral Therapy (HAART) in the Adult Population in the Ashanti Region of Ghana

AIDS is the late stage of infection with the Human Immunodeficiency Virus (HIV). Even though the Highly Active Antiretroviral Therapy (HAART) for the management of HIV/ AIDS has been in existence in Ghana since 2003, there is still limited data on their effectiveness. This study therefore sort to ascertain the effectiveness of HAART used at Anti-retroviral therapy (ART) Centres in the Ashanti region of Ghana by assessing its effects on immunological and haematological markers as well as some significant indicators such as body temperature and blood pressure changes. The study was a retrospective cross sectional study which reviewed medical record folders of 156 HIV infected patients who had attended the selected ART centres in the Ashanti region of Ghana between 2010 and 2014. About 49% of the study population had a significant rise in their CD4 counts after six months strict adherence to specific HAART regimen. HAART effectively reduced viral loads and increased CD4 counts in most of the patients whose medical record folders were reviewed. Socioeconomic factors, formal education and lack of health literacy had a significant effect on adherence to the HAART regimen, however; marital status of patients did not have any significant effect on adherence, CD4 counts and the haemoglobin concentration of patients. Based on results obtained from this study, HAART could be considered as effective in the adult population in the Ashanti region of Ghana provided there is a high level of adherence. Immunological and haematological markers for the assessment of effectiveness could also improve with high adherence recommended HAART regimen

Thrombocytopenia and Associated Factors Among HIV Infected Patients in Pre- and Post-Anti-Retroviral Therapy, North East Ethiopia.

BackgroundThrombocytopenia is a common disorder of HIV (human immunodeficiency virus) infection. The magnitude of thrombocytopenia and associated factors among HIV-infected patients receiving ART (anti-retroviral treatment) are not studied well in this study area. The aim of this study was to determine the prevalence of thrombocytopenia and associated factors in pre- and post-ART patients who attended Debre Berhan Referral Hospital (DBRH) in North-East Ethiopia.MethodsA hospital-based cross-sectional study was conducted from October to December 2020 in DBRH, North-East Ethiopia. From the total ART patients, 272 study participants were selected randomly. Socio-demographic variables and clinical characteristics of the patients were collected by standard questionnaires. Measurement of platelet count and CD4 count were made by Sysmex XT2000i hematology machine and BD FACS count analyzer, respectively. Data were analyzed with SPSS software version 23 and multivariate logistic regression was done. P-value less than 0.05 was taken as statistically significant.ResultsThe prevalence of thrombocytopenia was 22.7% with 95% CI: 17.8–27.5 in pre-ART and 14.7% with 95% CI: 11.0–19.9 in post-ART HIV-infected patients with a significant difference at P <0.0001. HIV patients with CD4 counts <200 cells/µL were more likely to have thrombocytopenia (35.0%) than patients with CD4 counts ≥200 with a P <0.04 in pre-ART patients. Patients on zidovudine (AZT)-based therapy were more likely to have thrombocytopenia (16.3%) than patients on tenofovir (TDF)-based therapy (14.8%) with P<0.79; however, this did not show any significant association.ConclusionThe prevalence of thrombocytopenia decreased significantly after the beginning of ART. HIV patients with low CD4 count and on AZT-based treatment showed high risk of thrombocytopenia. According to this study, thrombocytopenic patients were observed even after the initiation of ART. As a result, to decrease thrombocytopenic associated mortality and morbidity, there should be continuous screening for HIV-infected patients.

Mucocutaneous diseases in the combined antiretroviral therapy era: prevalence and spectrum in HIV seropositive children and adolescents in Durban, South Africa.

Mucocutaneous diseases (MCD) have been commonly described among human immunodeficiency virus (HIV) infected patients before the combined antiretroviral therapy (cART) era. There is limited data on the frequency and type of MCD in the cART era in African children and adolescents. This study aimed to describe the prevalence and spectrum of MCD in South African children and adolescents seropositive for HIV on cART. A cross-sectional study of 310 participants aged 0-19 years attending a public sector ART clinic at King Edward VIII Hospital, Durban, South Africa, was conducted. Demographic, clinical, and laboratory information was obtained from the participants and hospital records. Participants were examined. Data were collated and analyzed with SPSS version 23. MCD were observed in 77.4% of HIV-infected children. The prevalence was higher among males and adolescents above 16 years old (83.9%). Infectious skin disorders (44.7%) were less common than noninfectious dermatoses (55.3%). More common disorders encountered included generalized pruritus (32.6%), fungal infections (20.9%), and inflammatory (20.4%) and pigmentary (20.4%) skin disorders. Tinea capitis and pedis were the most prevalent fungal infections, while oral candidiasis (0.2%) was the least. Inflammatory skin disorders and dyschromia appeared to be more common than in the pre-cART era. While MCD are still common in HIV-infected children and adolescents in the cART era, the pattern and types of disorders have changed to a predominance of non-infectious dermatoses.

Interferon Gamma and Soluble MICA as A New Biomarker for Immunological Severity Detection in HIV Infected Patients Undergoing Retroviral Therapy

Objective: Variations in immune responses to viral particles and antiretroviral drugs show interference of the cluster of differentiation number 4 T cell monitoring methods, leading to an inaccurate evaluation for human immunodeficiency virus infected patients receiving antiretroviral therapy. Other biological markers; such as cytokine; especially interferon gamma (IFN-γ) and soluble molecules of major histocompatibility complex class I chain related molecule A (sMICA), were designed as a novel severity marker.Material and Methods: Levels of IFN-γ and sMICA were evaluated for 69 patients, who presented with HIV infection; with no other diseases or inflammation. The candidates were classified into four groups, depending on their CD4 T cell count. The IFN-γ and sMICA serum content of the patients was detected in triplicate, using enzyme-linked immunosorbent assay.Results: Mean value of IFN-γ in each severity group was 49.1±9.7, 69.1±21.8, 63.0±12.8, and 69.4±18.4 picograms/ milliliter for none, mild, advanced, and severe cases, respectively. sMICA was detected at 36.8±19.6, 134.7±122.5, 33.6±12.4, and 83.9±40.0 international unit/milliliter, respectively. A significant association between IFN-γ and CD4 cells of normal anti-retroviral treatment response, defined by CD4 cells and viral loads, was observed using Spearman correlation, with p-values 0.033, r -0.434, 0.026 and -0.321, respectively. Conclusion: IFN-γ and sMICA were found to be associated with the CD4 count in the normal responses to antiretroviral treatment. This suggested that IFN-γ could be used as a biological marker for monitoring of immunological severity during anti-retroviral responses.

Concurrent pulmonary tuberculosis and lepromatous leprosy in a newly diagnosed HIV positive patient: a case report

BackgroundThe leprosy-tuberculosis (TB) co-infection is rarely reported in recent times. However, this dual comorbidity is associated with high mortality and major morbidity. Unrecognised leprosy-TB co-infection may predispose affected patients to rifampicin monotherapy and subsequent drug resistance.Case presentationA 35 year old migrant, human immunodeficiency virus (HIV) positive male worker presented with 6 month history of symmetric infiltrative nodular plaques of the face and distal, upper extremities. A few days after initial dermatology presentation, a sputum positive pulmonary tuberculosis diagnosis was made at his base hospital. Subsequent dermatology investigations revealed histology confirmed lepromatous leprosy and a weakly reactive rapid plasma reagin test. The presenting clinical features and laboratory results were suggestive of lepromatous leprosy coexisting with pulmonary tuberculosis in an HIV positive patient.ConclusionsThis case illustrates the occurrence of leprosy with pulmonary tuberculosis in an HIV infected patient and the difficulties in interpreting non-treponemal syphilis tests in these patients. This case also highlights the need for a high index of suspicion for co-infection and the need to exclude PTB prior to initiation of rifampicin containing multi-drug therapy (MDT). Interdisciplinary management and social support are crucial in these patients.

Clinical Signs and Laboratory Parameters as Predictors of Mortality among Hospitalized Human Immunodeficiency Virus-Infected Adult Patients at Tertiary Hospital in Surabaya

BACKGROUND: The morbidity and mortality rates due to human immunodeficiency virus (HIV) infection are still high despite various and advanced efforts in the management given for HIV/AIDS patients. AIM: This study proposed that clinical signs and laboratory parameters could be expected to predict the patient’s mortality. METHODS: This retrospective study was done by collecting 408 medical records of adult HIV/AIDS inpatients at a tertiary hospital in Surabaya from January 1, 2017, to December 31, 2019. Bivariate analysis using Chi-square test was carried out on nine variables, which were Glasgow Coma Scale (GCS) &lt;15, hypotension, PaO2/FiO2 &lt;400 mmHg, elevated liver enzymes, hemoglobin levels &lt;10 mg/dl, platelet count &lt;150,000/mm3, eGFR &lt;60 ml/min/1.73 m2, albumin levels &lt;3.5 mg/dl, and body mass index (BMI) &lt;18.5 kg/m2. Variables which met the criteria would be included in the multivariate analysis using logistic regression. RESULTS: Based on bivariate analysis, mortality was found to be significantly associated with GCS &lt;15, hypotension, PaO2/FiO2, elevated liver enzymes, platelet count &lt;100,000 mm3, eGFR &lt;60 ml/1.73kg/m2, albumin levels &lt;3.5 mgdl, and BMI &lt;18.5 kg/m2. However, based on multivariate analysis, there were five variables which were found to be able to independently predict the patients’ mortality, those were GCS &lt;15 (OR 11.625), hypotension (OR 6.062), PaO2/FiO2&lt; 400 mmHg (OR 7.794), eGFR &lt;60 ml/min/1.73 m2 (OR 2.646), and albumin levels &lt;3.5 mg/dl (OR 4.091). CONCLUSION: GCS &lt;15, hypotension, PaO2/FiO2 &lt;400 mmHg, eGFR &lt;60 ml/1.73g/m2, and albumin levels &lt;3.5 mg/dl were found as the independent risk factors which could predict the hospitalized HIV/AIDS patients’ mortality.

Vancomycin resistant Enterococci and its associated factors among HIV infected patients on anti-retroviral therapy in Ethiopia.

The emergence of vancomycin resistant Enterococci (VRE) has alarmed the global community due to its tendency for colonization of the gastrointestinal tract. Human Immunodeficiency Virus (HIV) patients are colonized by vancomycin resistant Enterococci than other groups. The aim of this study was to determine the incidence of vancomycin resistant Enterococci and its associated factors among HIV infected patients on Anti-Retroviral Therapy (ART). Institution based cross sectional study was conducted among HIV infected patients on ART at from June 1 to August 30, 2020. Socio-demographic and clinical data were collected by pre-tested structured questionnaire. Stool sample was collected and processed by standard microbiological techniques. Kirby Bauer Disc diffusion method was used to perform antimicrobial susceptibility testing. Data were entered by Epi data version 4.6.0.2 and analyzed by SPSS version 25. Bivariable and multivariable logistic regression model was used to analyze the association between dependent and independent variables. P-values in the multivariable analysis, adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to determine the strength of association. P-value ≤0.05 was considered as significant. Enterococci spp was isolated on 123/200 (61.50%) patients. Among these isolates, the incidence of vancomycin resistant Enterococci was 11.4% [95% CI: (6.0-17.0)]. Antimicrobial susceptibility patterns against Enterococci showed highest rate of resistance to ampicillin (69.9%). Multidrug resistances were observed in 49.59% of Enterococci isolates. Study participants who had prior antibioticexposurer more than two weeks [AOR = 7.35; 95% CI: (1.2144.64)] and hospitalization for the last six months [AOR = 5.68; 95% CI: (1.09 29.74)] were significantly associated with vancomycin resistant Enterococci. In our study high incidence of vancomycin resistant Enterococci was found. Previous exposure to antibiotics for more than two weeks and hospitalization for more than six months were significantly associated with vancomycin resistant Enterococci. The isolated Enterococci had variable degrees of resistance to commonly prescribed antibiotics. Therefore, periodic surveillance on antimicrobial resistance pattern, adhering to rational use of antibiotics and implementing infection prevention protocols may reduce colonization by VRE.

Profile of Deaths in HIV Infected Patients: A 5 Year Retrospective Study from Western Maharashtra

This is a retrospective study of deaths in human immunodeficiency virus (HIV) infected patients at GrantMedical college and Sir JJ group of hospitals, Mumbai from July 2000 up to June 2005 to determine statisticaldistribution with respect to age, sex and occupation , study clinical profile and causes of deaths among theHIV positive cases. For this we analysed the clinical records and autopsy reports of total 11092 deathsoccurred during study period; out of these 1466 (13.2%) were HIV positive deaths. Out of those 1466 HIV,maximum cases (54%) were in the age group 31-40 years; Males (78%) clearly outnumbered the femalepopulation in the present study. Regarding occupation wise incidence, in 5% cases factory workers weremainly affected. In the present study, clinically pulmonary tuberculosis was found in 40% cases, tuberculousmeningitis was found in 21% cases and pneumonia was found in the 15% cases. Pulmonary tuberculosis wasthe immediate cause of death in 40% cases in the present study. Tuberculous meningitis and pneumonia werealso the common causes of death in the present study.

Prevalence of low bone mineral density in Human Immunodeficiency Virus-infected patients and its correlation with other determinants

Background: The patients infected with human immunodeficiency virus (HIV) are potentially at risk of low bone mineral density (BMD). The present study was done to find out the prevalence of low BMD in HIV-infected patients and its correlation with other factors such as gender, body mass index (BMI), CD4 count, and highly active antiretroviral therapy (HAART). Methods: This was an observational cross-sectional study conducted in a tertiary care center for 1 year period. A total of 127 HIV-infected patients were evaluated for BMD by dual-energy X-ray absorptiometry (DEXA) scans at two sites lumbosacral spine and bilateral neck femur. Correlation with other factors was also studied. Results: The diagnosis of low BMD was established in 105 (82.67%) patients. Osteoporosis (44.1%) was more common than osteopenia (38.6%) at the lumbosacral spine. The mean T score of the DEXA lumbar spine and bilateral neck femur was observed to be ?2.113 and ?1.379, respectively. Males (88.73%) had low BMD than females (75%). Approximately 94.5% of subjects having BMI &lt;18 had low BMD in contrast to 80.8% among subjects having BMI &gt;18. After treatment, 47 patients had CD4 count &lt;400 and 80 &gt; 400. Forty-three patients out of 47 (91.5%) had low BMD and 62 out of 80 (77.5%) had low BMD. Conclusion: Low BMD is prevalent in HIV-infected subjects. Low BMI, persistently low CD4 count, tenofovir containing HAART regimen showed a positive correlation with low BMD. Hence, HIV infection should be considered as a risk factor for bone disease.