Human Immunodeficiency Virus Infected Patients Research Articles

Progression of subclinical cardiovascular disease in patients with HIV.

Human immunodeficiency virus (HIV) infected patients are at increased risk of cardiovascular disease (CVD). Multidetector computed tomography (MDCT) stratifies cardiovascular risk in asymptomatic patients with subclinical atherosclerosis. The aim of this study was to determine the ability of MCTD and clinical and laboratory parameters to assess subclinical CVD progression in HIV patients. Prospective longitudinal cohort study of patients with at least 10 years of HIV infection and 5 years of antiretroviral therapy history, low cardiovascular risk and monitored for 6 years (2015-2021). All patients underwent clinical assessment, blood analysis, carotid ultrasound, and gated MDCT in 2015 and 2021. Sixty-three patients (63.5% male) with a mean age of 49.9 years (standard deviation [SD], 10.5) were included in 2015; 63 of them were followed until 2021. Comparing the results from 2015 with those from 2021, Systematic Coronary Risk Estimation-2 (SCORE2) was 2.9% (SD, 2.1) vs. 4.4% (SD,3.1); Multi-Ethnic Study of Atherosclerosis score (MESA risk) was 3.4 (SD 5.8) vs. 6.0 (SD 8.6); coronary artery calcification CAC) score >100 was 11.1% vs. 25.4% (P < 0.05); and 11% vs. 27% had carotid plaques (P = 0.03). After six years of follow-up, an increase in SCORE2, carotid plaques, CAC scoring and MESA risk was observed. MDCT findings, along with other clinical and laboratory parameters, could play an important role as a marker of CVD progression in the evaluation of patients with HIV and low cardiovascular risk.

Current status of liver transplantation for human immunodeficiency virus-infected patients in mainland China

According to the report from the Chinese Center for Disease Control and Prevention, the prevalence of human immunodeficiency virus (HIV) infection exceeded 1.2 million individuals by the year 2022, with an annual increase of about 80000 cases. The overall prevalence of hepatitis B surface antigen among individuals co-infected with HIV reached 13.7%, almost twice the rate of the general population in China. In addition to the well-documented susceptibility to opportunistic infections and new malignancies, HIV infected patients frequently experience liver-related organ damage, with the liver and kidneys being the most commonly affected. This often leads to the development of end-stage liver and kidney diseases. Therefore, organ transplantation has emerged as an important part of active treatment for HIV infected patients. However, the curative effect is not satisfactory. HIV infection has been considered a contraindication for organ transplantation. Until the emergence of highly active anti-retroviral therapy in 1996, the once intractable replication of retrovirus was effectively inhibited. With prolonged survival, the failure of important organs has become the main cause of death among HIV patients. Therefore, transplant centers worldwide have resumed exploration of organ transplantation for HIV-infected individuals and reached a positive conclusion. This study provides an overview of the current landscape of HIV-positive patients receiving liver transplantation (LT) in mainland China. To date, our transplant center has conducted LT for eight end-stage liver disease patients co-infected with HIV, and all but one, who died two months postoperatively due to sepsis and progressive multi-organ failure, have survived. Comparative analysis with hepatitis B virus-infected patients during the same period revealed no statistically significant differences in acute rejection reactions, cytomegalovirus infection, bacteremia, pulmonary infections, acute kidney injury, new-onset cancers, or vascular and biliary complications.

Predictors of severe hepatotoxicity among retroviral infected adults on HAART regimen in Ilubabor Zone, Southwest Ethiopia

Nearly half of the deaths among hospitalized human immuno deficiency virus-infected patients in the highly active antiretroviral therapy era have been attributed to liver disease. This may range from an asymptomatic mild increase of liver enzymes to cirrhosis and liver failure. Different works of literature elucidated both retroviral infection and the adverse effects of highly active antiretroviral therapy as a cause of hepatotoxicity. Individual adaptations to medications and environmental exposures, shaped by cultural norms and genetic predispositions, could potentially modulate the risk and progression of liver disease in this population. Therefore, this study aims to assess the predictors of severe hepatotoxicity in retroviral-infected adults receiving highly active antiretroviral therapy regimens within the Ilubabor Zone, Southwest Ethiopia. A facility-based cross-sectional study was conducted among adult retroviral-infected patients in five selected anti-retro virus therapy clinics from May1 to July 30/2022. A systematic sampling technique was used to select 457 study participants and Binary logistic regression statistical data analysis was used, P value < 0.05 was considered statistically significant. The prevalence of severe hepatotoxicity was 21.44% in the study population. CD+4 count < 200 cells/mm3 (AOR = 2.19, 95% CI 1.04–5.22, P = 0.01), human immunodeficiency virus co-infection with tuberculosis (AOR = 2.82, 95% CI 1.01–8.29, P = 0.03) and human immuno deficiency virus co-infection with hepatitis-B/hepatitis C virus (AOR = 5.02, 95% CI 1.82–16.41) were predictors of severe hepatotoxicity. The magnitude of severe hepatotoxicity was high among adult retroviral-infected patients on highly active anti-retroviral drug regimens. Co-infection of human immuno deficiency virus with hepatitis B virus or hepatitis C virus, tuberculosis and CD4+T-cell count below 200 cells/mm3 were predictors of severe hepatotoxicity. Therefore, HIV patients on highly active antiretroviral therapy require close attention and regular monitoring of their liver function.

Distinct Lipidomic Profiles between People Living with HIV Treated with E/C/F/TAF or B/F/TAF: An Open-Label Prospective Cohort Study.

Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF) has been increasingly replaced by bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in the treatment of human immunodeficiency virus (HIV) owing to its more favorable pharmacokinetics and fewer drug-drug interactions. However, the effect of this switch on plasma lipids and lipidomic profiles remains poorly characterized. HIV infected patients on an E/C/F/TAF regimen were recruited into the study and followed up every 12weeks. Participants were divided into E/C/F/TAF and B/F/TAF groups depending on whether they were switched to B/F/TAF during follow-up. Clinical information and blood samples were collected at 0, 12, and 24weeks, and lipidomic analysis was performed using liquid chromatography mass spectrometry. No significant differences were observed between the groups at baseline. At week 24, patients switched to B/F/TAF had lower triglyceride [mmol/L; 1.23 (0.62) versus 2.03 (0.75), P = 0.001] and very low-density lipoprotein cholesterol [mmol/L; 0.64 (0.26) versus 0.84 (0.32), P = 0.037) compared with patients who continued E/C/F/TAF therapy. Small decrease from baseline in Framingham general cardiovascular risk score (FRS) was observed in the B/F/TAF arm [week (W) 0: 2.59 (1.57) versus W24: 2.18 (1.01), P = 0.043]. Lipidomic analysis indicated that E/C/F/TAF treatment increased the levels of several diglycerides (DGs), triacylglycerols (TAGs), and lyso-phosphatidylcholines (LPCs), whereas switching to B/F/TAF led to increased sphingolipids and glycerophospholipids. After adjusting for demographic and clinical parameters, only DG (16:0/18:2), DG (18:2/22:6), DG (18:3/18:2), DG (20:5/18:2), TAG (18:3/18:2/21:5), TAG (20:5/18:2/22:6), and LPC (22:6) were found to be significantly associated with FRS (regression coefficient of 0.17-6.02, P < 0.05). Most of these FRS associate lipid species were significantly elevated in individuals treated with E/C/F/TAF instead of individuals treated with B/F/TAF. E/C/F/TAF promotes the accumulation of lipid species closely associated with cardiovascular disease (CVD) risk among people living with HIV, whereas B/F/TAF has a decreased impact on CVD-related lipid profile and is associated with lower CVD risk. A graphical abstract is available with this article. ClinicalTrials.gov; identifier, NCT06019273.

Social stigma and discrimination towards people living with HIV infection and AIDS patients

Background: Social stigma and discrimination are major barriers to an effective national response to human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), and there have been repeated calls to transform the current surveillance-focused policy. Serious instances of discrimination and clinical service failings increase the urgency and importance of addressing issues relevant to AIDS-related stigma. Yet, progress in achieving effective and people-centered responses to AIDS is insufficient.Current Concepts: Based on a comprehensive multi-sectoral review of a wide range of literature, this article examines the key features of AIDS-related stigma in South Korea and evaluates governmental and organizational efforts to redress them. Three major areas, of issues and possibilities for change, are identified: (1) addressing discrimination in health care settings, (2) decriminalization of HIV transmission, according to the Undetectable=Untransmittable (U=U) principle, (3) improving the quality of life and social inclusion of people living with HIV.Discussion and Conclusion: An extensive examination of existing evidence on AIDS-related stigma, guided by the authors’ long-term experience of public participation and civic empowerment, suggests that by placing these three issues at the center of the national response to AIDS, significant improvement in the AIDS care continuum is achievable. People-centered service delivery models that focus on dismantling structural barriers and incorporating leadership from key populations will enable high-impact public health responses to AIDS and HIV infection.

Healthcare policy to support people living with HIV infection and AIDS patients

Background: Individuals living with human immunodeficiency virus (HIV) encounter challenges throughout the care continuum, right from the time of diagnosis to the culmination of the treatment process.Current Concepts: The Republic of Korea, like many other countries, has been addressing the needs of people living with HIV (PLWH) by providing financial support for medical expenditures. Currently, HIV counseling specialist nurses offer psychological support at 28 institutions, assisting patients in maintaining viral suppression state and adhering to antiretroviral therapy. Care and welfare services are also provided by non-governmental organizations funded by the Korean Disease Control and Prevention Agency (KDCA). The accessibility of medical institutions for PLWH has seen gradual improvement, with KDCA issuing guidelines for healthcare facilities catering to this population. In addition, the legal and medical insurance coverage issues related to long-term care institutionalization have been addressed. However, PLWH continues to face challenges in treatment and hospitalization, especially with a recent increase in immigrant PLWH, highlighting a lack of support for undocumented immigrants seeking treatment.Discussion and Conclusion: Healthcare policies are shifting from merely managing, isolating, and treating PLWH to prioritizing their human rights. Going forward, it is imperative to empower PLWH and support their self-care efforts.

Features of clinical manifestations of secondary syphilis in a HIV infected patient

Syphilis and human immunodeficiency virus (HIV) infection are diseases of an infectious nature with a predominantly sexual route of infection. Despite the decrease in the incidence of syphilis in recent years in Russia, there is an increase in HIV infection.&#x0D; The combination of several infections in one patient leads to changes in clinical manifestations, which sometimes significantly complicates their diagnosis, leading to a late start of treatment. Syphilis against the background of HIV infection proceeds in stages, but usually it has a malignant, aggressive and severe course, often with the development of atypical forms and complications.&#x0D; The primary syphilis against the background of HIV infection is characterized by the appearance of ulcerative-necrotic character of the hard chancre, such severe complications as phagedenism and gangrenization, the frequent addition of a secondary infection, severe soreness of the hard chancre. Secondary syphilides in HIV-infected patients are characterized by the appearance of ulceration with the formation of necrotizing vasculitis, extraordinary infectiousness of the elements. The disease progresses rapidly and over a few months from the moment of infection, manifest neurosyphilis or tertiary syphilis may develop due to immunodeficiency.&#x0D; The authors describe the features of the manifestations of syphilis in its different periods against the background of HIV infection. A clinical case of a 35-year-old woman who was diagnosed with secondary syphilis and HIV infection is presented. The patient had numerous skin rashes, which were interpreted differently by doctors of different specialties for 2 months. The patient was diagnosed with pyoderma, "allergy", infectious exanthema, however, against the background of the treatment, there was a negative dynamics of the skin process. The authors have demonstrated the effectiveness of specific therapy: complete resolution of skin rashes.

Nanobody-mediated neutralization of candidalysin prevents epithelial damage and inflammatory responses that drive vulvovaginal candidiasis pathogenesis.

Candida albicans can cause mucosal infections in humans. This includes oropharyngeal candidiasis, which is commonly observed in human immunodeficiency virus infected patients, and vulvovaginal candidiasis (VVC), which is the most frequent manifestation of candidiasis. Epithelial cell invasion by C. albicans hyphae is accompanied by the secretion of candidalysin, a peptide toxin that causes epithelial cell cytotoxicity. During vaginal infections, candidalysin-driven tissue damage triggers epithelial signaling pathways, leading to hyperinflammatory responses and immunopathology, a hallmark of VVC. Therefore, we proposed blocking candidalysin activity using nanobodies to reduce epithelial damage and inflammation as a therapeutic strategy for VVC. Anti-candidalysin nanobodies were confirmed to localize around epithelial-invading C. albicans hyphae, even within the invasion pocket where candidalysin is secreted. The nanobodies reduced candidalysin-induced damage to epithelial cells and downstream proinflammatory responses. Accordingly, the nanobodies also decreased neutrophil activation and recruitment. In silico mathematical modeling enabled the quantification of epithelial damage caused by candidalysin under various nanobody dosing strategies. Thus, nanobody-mediated neutralization of candidalysin offers a novel therapeutic approach to block immunopathogenic events during VVC and alleviate symptoms.IMPORTANCEWorldwide, vaginal infections caused by Candida albicans (VVC) annually affect millions of women, with symptoms significantly impacting quality of life. Current treatments are based on anti-fungals and probiotics that target the fungus. However, in some cases, infections are recurrent, called recurrent VVC, which often fails to respond to treatment. Vaginal mucosal tissue damage caused by the C. albicans peptide toxin candidalysin is a key driver in the induction of hyperinflammatory responses that fail to clear the infection and contribute to immunopathology and disease severity. In this pre-clinical evaluation, we show that nanobody-mediated candidalysin neutralization reduces tissue damage and thereby limits inflammation. Implementation of candidalysin-neutralizing nanobodies may prove an attractive strategy to alleviate symptoms in complicated VVC cases.

Evaluation of First-Line Coagulation Tests in Highly Active Antiretroviral Therapy (HAART) Naïve and Treated Group of HIV Infected Subjects

Background: Coagulation disorders are common in patients with Human Immunodeficiency virus (HIV). Coagulation abnormalities occur as a result of HIV-related thrombocytopenia, induced hepatotoxicity due to highly active antiretroviral therapy (HAART) that impairs liver function and diminishes the function and synthesis of coagulation factors. The aim of this study was to evaluate prothrombin time (PT), activated partial thromboplastin time (APTT), platelet count, mean platelet volume, plateletcrit and platelet distribution width in HAART-naïve HIV infected patients, HAART treated and HIV-seronegative controls.&#x0D; Place and Duration of Study: Department of Haematology and antiretroviraltherapies (ART) clinic both of Enugu State University of Science and Technology Teaching Hospital, between March and June 2023.&#x0D; Methodology: A total of 150 study participants, consisting of 50 HAART-naïve HIV-infected subjects, 50 HIV-infected subjects who were taking HAART, and 50 HIV-seronegative apparently healthy subjects, were included. Coagulation tests such as PT, APTT were determined by manual procedures. Platelet counts (PC), mean platelet volume (MPV), plateletcrit (PCT), platelet distribution width (PDW) were analyzed by Mindray/BC-5150 automated analyzer. The data were analyzed using SPSS version 21. Analysis of variance (ANOVA) and Pearson correlation analysis were used. P-Value &lt; 0.05 was considered as statistically significant.&#x0D; Results: Mild thrombocytopenia (100-&lt;150 x 109/L) was found in 48% of HIV-infected subjects who were taking HAART, 76% mild thrombocytopenia and 24% moderate thrombocytopenia (50-&lt;100 x109/L) was found in HAART-naïve HIV-infected subjects, but no thrombocytopenia was found in apparently healthy HIV-seronegative control. Prothrombin time and APTT were significantly higher, whereas PC and PDW was significantly lower in HIV-infected subjects (both who were taking HAART and HAART-naïve) than HIV-seronegative subjects (p&lt;0.05). Prothrombin time and APTT were significantly higher, and PC was significantly lower in HAART-naïve HIV-infected subjects than HIV-infected subjects who were taking HAART. In Pearson correlation analysis, PT and APTT has shown a significant negative correlation with a PC in those taking HAART and HAART-naïve HIV-infected subjects, whereas significant positive correlation was found in HIV-seronegative subjects.&#x0D; Conclusion: Prothrombin time and APTT significantly increased, whereas platelet count and PDW significantly decreased in HIV-infected subjects who were taking HAART and HAART-naïve. Basic coagulation parameters need to be monitored regularly in HIV-infected subjects in Enugu.

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 &gt; 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

Socio-demographic, economic and behavioral determinants of loss to follow-up status among human immunodeficiency virus-infected patients in southern Benin in 2020

Background: The recurrence of cases lost to follow-up constitutes a major concern for human immunodeficiency virus (HIV) care programs, particularly in Africa. The present study was carried out to determine the economic and socio-behavioral factors associated with the status of loss to follow-up among HIV-infected patients followed at the Suru Lere Zonal Teaching Hospital Center in Benin. Methods: This was a case-control study carried out with 41 cases selected for convenience and 82 controls retained according to a reasoned choice. Matching was done on the variables age (±5 years), sex and year of initiation of treatment. The data collected using questionnaires and counting sheets then entered using the Epi data 3.1 software were analyzed using the STATA 11 software. A multiple conditional logistic regression model at the 5% threshold was used to determine factors associated with “lost to follow-up” status. Results: In the sample, the average age of the people surveyed was 41±9 years for both cases and controls and women were predominantly represented (63.41%). The factors associated with the status of loss to follow-up were the non-existence of a means of transport (p=0.008), the lack of nutritional support (p=0.01), incorrect knowledge about antiretroviral treatment such as “ARVs cure HIV/AIDS” (p=0.002) or “treatment can be stopped when you feel better” (p=0.014). Conclusions: This study revealed the significant association of “lost to follow-up” status with socio-demographic, economic and behavioral factors among people on ARV treatment. These results will lead to better guide the care of these patients and improve the performance of the AIDS control program.

2108. In-vitro Activity of Five Novel Anti-Fungal Compounds Against Thirty-Two Strains of Talaromyces marneffei

Abstract Background Talaromyces marneffei (Tm) is a thermally dimorphic fungus causing invasive mycosis in human immunodeficiency virus (HIV) infected patients in Southeast Asia and is a leading cause of AIDS-related deaths in this region with mortality on anti-fungal therapy as high as 30%. The limited options, routes of administration, and toxicity of antifungals with established efficacy against Tm calls for assessment of efficacy for additional antifungals against Tm. Here we evaluate the in-vitro efficacy of 5 novel anti-fungal agents against 32 clinical strains of Tm. The agents tested include ibrexafungerp, two manogepix compounds (APX001A and APX2039), olorofim, and oteseconazole. Methods 32 Tm isolates were cultured from clinical samples from patients in Vietnam and identified as Tm by standard morphological characteristics. Inocula were prepared from these clinical samples in conjunction with CLSI standards and plated onto 96-well microplates. Concentrations for each drug ranged from 0.008 µg/mL to 4 µg/mL. AlamarBlueTM, a resazurin-based cell viability indicator dye, was added to the drug-inoculum solution. Use of this reagent enabled utilization of a microplate fluorescence intensity(FI) reader to objectively identify the designated MIC endpoint of 50% inhibition of growth. Methods (Figure 1). MIC endpoint determination using AlamarBlue indicator dye method. Clinical Tm isolates were thawed and plated on Yeast Peptone Dextrose (YPD) agar and grown for 3-5 days at 37°C. Isolates were then sub-cultured on fresh YPD agar and allowed to grow for 3 days prior to inoculum preparation. Inocula were prepared according to CLSI standards. Following suspension in solution, inocula were diluted in PBS until an optical density (OD) of 0.5 to 0.6 was achieved. Inocula were further diluted in RPMI + MOPS and added to the drug-dilution microplates to achieve a final concentration of 1000-5000 cells/mL. After incubation at 37°C for 24 hours, AlamarBlue was added to all wells. Following incubation for an additional 48 hours, fluorescence intensity (FI) was measured using a microplate reader to determine the MIC endpoint of 50% inhibition of fungal growth. Results Of the drugs tested, olorofim showed the highest activity against the 32 isolates, with MICs consistently ≤ 0.008 µg/mL. This was followed by oteseconazole with MICs between ≤ 0.008 and 0.031 µg/mL APX001A with MICs between 0.031 and 0.25 µg/mL and APX2039 with MICs between 0.25 and 4 µg/mL. Ibrexafungerp had the broadest MIC distribution with MICs between 0.063 and 4 µg/mL. Figure 2/Table 1. MIC Endpoint Distribution. Figure 2 shows a scatter plot of MIC endpoints for each drug. Error bars demonstrate the geometric mean and 95% confidence intervals. Table 1 illustrates the MIC endpoint distribution in a graded heat map format. In addition, the absolute values of the geometric mean (GM), mode, MIC50, and MIC90 are displayed at the right side of the table. Both Figure 2 and Table 1 illustrate high efficacy for olorofim and oteseconazole, with low MIC endpoints consistent across the 32 isolates. The manogepix compounds(APX001A and APX2039) demonstrate surprisingly contrasted performance against Tm, despite the similar chemical structure and identical mechanism of action of the drugs. APX001A had significantly lower MIC endpoints compared to APX2039. Ibrexafungerp had the broadest range of MIC endpoints from 0.063 to 4µg/mL and the highest MIC50 and MIC90 of all the drugs. However, a significant proportion of isolates were highly susceptible to the drug. Conclusion In-vitro activity of the 5 drugs tested against the 32 Tm strains was variable, but all should be considered potential candidates for treating Tm infection. To further evaluate the potential role of each drug in treating Tm infection, the next step should be to evaluate each in in-vivo models. Disclosures All Authors: No reported disclosures

An evaluation of Mp1p antigen screening for talaromycosis in HIV-infected antiretroviral therapy-naïve population in Guangdong, China.

Talaromycosis is one of the most common opportunistic infections in human immunodeficiency virus (HIV) infected patients. However, few researches have explored the prevalence in Southern China and fully assessed the value of the Mp1p antigen screening for the diagnosis of talaromycosis. We performed a cross-sectional study of HIV-infected antiretroviral therapy (ART)-naïve adult patients who were seen in 2018 at Guangzhou Eighth People's Hospital, Guangzhou Medical University. Serum samples collected from all the 784 enrolled patients were tested for Mp1p antigen using double-antibody sandwich enzyme-linked immunosorbent assay. A culture of pathogen was conducted in 350 clinically suspected patients to confirm talaromycosis. The overall prevalence of talaromycosis based on the Mp1p antigen detection was 11.4% (89/784) and peaked at 32.2% (75/233) in patients with CD4+ ≤50 Nr/μl. Logistic regression analysis found Mp1p antigen positive rate decreased with the increase in CD4+ counts (OR 0.982, 95% CI 0.977-0.987, P<0.01). The optimal cut-off point of the CD4+ count was 50 Nr/μl or less. Among the 350 patients received both fungal culture and Mp1p antigen detection, 95/350 (27.1%) patients were culture-positive for a Talaromyces marneffei, 75/350 (21.4%) patients were Mp1p antigen positive. The Mp1p antigen assay showed a good agreement to the culture of pathogen, and the sensitivity, specificity, positive predictive value, negative predictive value and kappa value was 71.6% (68/95), 97.3% (248/255), 90.7% (68/75), 90.2% (248/275), and 0.737, respectively. The screening accuracy of the Mp1p antigen assay in patients with CD4+ counts of ≤50 Nr/μl was superior to that in those with higher CD4+ counts. Mp1p antigen screening can be an effective tool for more efficient diagnosis of Talaromycosis, especially in HIV/AIDS patients with low CD4+ counts. Future validation studies are needed.

Clinicopathologic Characterization of Kaposi Sarcoma on the Foot and Ankle: Analysis of 11 Patients Seen in Our Clinics.

Kaposi sarcoma (KS) has multiple clinical variants, and most frequently presents on the lower extremities. Anti-human immunodeficiency virus (HIV) therapy has significantly reduced the incidence of KS. However, KS is still prevalent in both HIV-infected and HIV-uninfected patients. This case series analysis aims to reveal the clinical presentations, differential diagnosis, and treatment options of KS on the foot and ankle. Eleven cases of KS involving the foot and ankle were retrieved from our patient database, and their clinicopathologic features were analyzed. All patients were men, aged 29 to 85 years. Two types of KS were found: classic and acquired immunodeficiency syndrome-associated epidemic. The average ages of classic and epidemic KS were 65.7 and 41.8 years, respectively. Clinically, three patients manifested multiple erythematous or deep violaceous, or blue-violaceous macules on either the dorsal or plantar surfaces of both feet. Eight patients showed exophytic, pyogenic granuloma-like nodules on the plantar surface, heels, and toes. Histologically, all KSs had uniform intervening fascicles of elongated spindle cells with slit-like vascular spaces filled with red blood cells and immunoreactivity with human herpesvirus-8. The patients were treated according to HIV infection status. Human immunodeficiency virus-infected patients were treated with anti-HIV therapy after primary surgical excision or biopsy. Human immunodeficiency virus-negative patients were treated with either surgical excision, Mohs surgery, or a combination of surgical excision and local radiotherapy according to individual patient clinical presentation. Kaposi sarcoma is still prevalent in both HIV-infected and HIV-uninfected patients with a variety of clinical presentations. Biopsy, with histologic evaluation, in combination with immunohistochemistry is essential for the differential diagnosis. The patient should be treated according their clinical manifestation, staging, comorbidity, and immune function.

TO DETERMINE THE ZINC LEVEL AND ITS CORRELATION WITH CD4 COUNT BEFORE AND AFTER ZINC SUPPLEMENTATION IN HIV INFECTED PATIENTS

Introduction: Human immunodeficiency virus (HIV) infection is a state of profound immunodeficiency. Zinc is a known to maintain a healthy immune system. Low levels of zinc in plasma predict a threefold increase in mortality related to HIV, while adequate levels of the zinc in the blood have been associated with a slow disease progression, decrease in viral load and HIV RNA, increase in CD4 count, a decrease in the risk for diarrhea, bacterial and opportunistic infections.Zinc deficiency which is common among the HIV infected persons, is overlooked So, we conducted this study to analyze the level of serum zinc level in HIV infected patients and to find out correlation between serum zinc level and CD4 count before and after 6 months of zinc supplementation. Methods: This study enrolled 54 HIV infected patients above 18 years of age who visited the Medicine outpatient department or the ART Centeror admitted to the medicine ward, Regional institute of Medical Sciences (RIMS), Imphalfor a period of 2 years(October 2019 to October 2021). Serum zinc level, CD4 count, HIV viral load before and after 6 months of zinc supplementation and other routine blood investigations were done. Zinc deficiency was defined by serum Zinc level (&lt; 70mcg/dl).Zinc supplementation (12 mg/day for female, 15 mg/day for male) had been done for the duration of 6 months in the form of oral zinc sulfate. Result: A total of 54 HIV infected patients under ART were enrolled in our study. As per WHO clinical staging, majority of the patients (79.6%) belonged to stage1, the mean duration + SD of HIV was 10.9815 + 8.1229 years. Most of them (46.3%) have CD4 count in the range of 200-500 cells/mm3 while maximum patients (70.4%) had viral load &lt;50 (Target not detected). Majority of the patients (50%) had serum zinc level in the 60-70 mcg/dl while 18.5% of them had zinc level &lt; 50 mcg/dl. There was statistically significant improvement in level of serum zinc and CD4 count, but no improvement in viral load after 6 months of supplementation of zinc.The association with CD4 count was not statistically significant. Conclusion: The present study showed that the majority of patients (92.6%) had zinc deficiency at baseline. There was increase in the mean serum zinc level, CD4 count after 6months of zinc supplementation but no improvement in viral load. Zinc deficiency was reduced to only (31.5%) patients. Hence, this study conclude that zinc deficiency is common among HIV patients and zinc supplementation as an adjunct therapy can significantly improve zinc deficiency and CD4 count in HIV infected patients on ART without any adverse side-effects of zinc supplementation thereby decreasing the risk for bacterial and opportunistic infections.

Emergomycosis, an Emerging Thermally Dimorphic Fungal Infection: A Systematic Review.

Emergomycosis is an endemic mycosis caused by the Emergomyces species. Infections due to this agent have been reported globally. Hence, the present systematic review on Emergomyces infections was conducted to study the disease epidemiology, underlying diseases and risk factors, causative agents, and treatment and outcome. The MEDLINE, Scopus, Embase, and Web of Science databases were searched systematically with appropriate keywords from January 1990 to October 2022. A total of 77 cases of emergomycosis were included in the analysis. Emergomycosis was most commonly seen in patients with human immunodeficiency virus (HIV) infection (n = 61, 79.2%) and HIV-uninfected patients with or without other comorbidities (n = 16, 20.8%). The underlying disease and risk factors significantly associated with emergomycosis in the HIV-infected patients were CD4+ T-cell counts less than 100 cells/mm3 (n = 55, 90.2%), anaemia (n = 30, 49.2%), and thrombocytopenia (n = 17, 27.9%), whereas in the HIV-uninfected patients, treatment with immunosuppressive drugs (n = 10, 62.5%), renal disease (n = 8, 50%), transplant recipients (n = 6, 37.5%), and diabetes mellitus (n = 4, 25%) were the significant risk factors associated with emergomycosis. Emergomyces africanus (n = 55, 71.4%) is the most common causative agent, followed by E. pasteurianus (n = 9, 11.7%) and E. canadensis (n = 5, 6.5%). E. africanus was most often isolated from HIV-infected patients (n = 54, 98.2%), whereas E. pasteurianus was most common in HIV-uninfected patients (n = 5, 55.6%). The all-cause mortality rate of the total cohort is 42.9%. No significant variation in the mortality rate is observed between the HIV-infected patients (n = 28, 36.4%) and the HIV-uninfected patients (n = 5, 6.5%). In conclusion, with an increase in the immunosuppressed population across the globe in addition to HIV infection, the case burden of emergomycosis may increase in the future. Hence, clinicians and mycologists should be vigilant and clinically suspicious of emergomycosis, which helps in early diagnosis and initiation of antifungal treatment to prevent disease mortality.

Immunohematological Outcome Among Adult HIV Patients Taking Highly Active Antiretroviral Therapy for at Least Six Months in Yabelo Hospital, Borana, Ethiopia.

Immunohematological abnormalities among human immunodeficiency virus-infected patients are common abnormalities associated with severe depletion of the immune system, covering a stage of acute syndrome to an advanced disease. The greatest impact was observed in the low- and middle-income countries. However, in Ethiopia, little attention has been paid, and only limited published information exists regarding immunohematological abnormalities among individuals receiving highly active antiretroviral treatment. This study aimed to assess changes in immunological and hematological parameters in HIV-infected patients receiving HAART for at least six months at the antiretroviral therapy clinic of Yabelo Hospital, Borena, Ethiopia. A cross-sectional study was conducted from February to July 2021 using convenient sampling to recruit 333 participants. Sociodemographic data and clinical characteristics were collected using a pretested questionnaire. Baseline data were extracted from medical records and after six month immunohematological measurements were performed on blood samples collected during the study period. Data analysis was performed using SPSS version 25. Descriptive analysis was performed, and the results are presented as numbers and percentages or means ± SD. A paired t-test was used to compare the mean values of the immunohematological parameters before and after six of taking HAART. Statistical significance was set at P < 0.05. The prevalence of anemia, leucopenia, neutropenia, lymphopenia and thrombocytopenia were 47.4%, 73.3%, 58.3%, 76.9% and 3.3% before initiation of HAART and 23.1%, 36.4%, 23.4%, 35.7% and 2.4% after initiation of HAART, respectively; Compared to baseline, there was also a significant decrease in the rate of Immunosuppression (CD4 < 350) from 62.2% at base line to 20.7% after HAART initiation. Immunohematological profile of the patients improved after the initiation of HAART. The observation of large proportion of immunosuppressed individuals at baseline warrants advocating for HIV testing in the pastoralist community so that infected patients could benefit from early initiation of HAART.

Investigation of hepatitis B virus mutations associated with immune escape and drug resistance in human immunodeficiency virus-infected patients

Background: HBV/HIV co-infection impact on high HBV replication, progression to liver cancer and high mortality. Co-infection may lead to cross-resistance of HBV and HIV drugs due to immune therapy pressure or hepatotoxicity. These challenges necessitate continuous monitoring of HBV variants to aid better diagnosis and treatment strategies. We conducted this study to characterise HBV among HIV infected individuals. Methods: Serum was screened for HBsAg using ELISA, followed by DNA extraction, PCR amplification, Sanger sequencing and phylogenetic analysis. Results: Of the 50 samples in this study 100% (N=50/50) were HBsAg positive; 78% (N=41/50) HBV/HIV co-infection and 92% (N=38/41) of the amplicons were successfully sequenced. Samples nucleotide sequences were identified as genotype A. Mutations prevalence in the HBsAg region was 47% (N=18/38); including mutations associated with diagnostic failure (K122R and T143S) and 7 vaccines escape mutations (P127T, G145R, S207N, Y200T, E164D, Y206H and L209V). Mutations showed resistance to lamivudine 71% (n=5/7), telbivudine 57% (n=4/7), 14% (n=1/7) for entecavir and 43% (n=3/7) for adefovir. Mutations causing resistance to lamivudine and telbivudine were M204V, L180M, V163I, and S202K; with S202K also causing resistance to entecavir and adefovir resistance mutation were I253Y, I223V and M250I. Multiple drug resistance mutations within a single sample contained L180M, M204V, S202K and M250I mutations.  There was no statistical significance between the RT mutations associated with drug resistance at P&gt;0.005. The correlation test exhibited a weak statistical association between SHB and RT mutations (0.877**). Conclusions: This study shows the predominance of HBV genotype A in HIV-infected patients. We discovered HBV mutations linked to immune evasion and drug resistance. Although there is no statistical significance amongst the mutations associated with drug resistance and vaccine escape. These mutations could have clinical implications that could have therapeutic repercussions by influencing the correct clinical diagnosis and treatment in HBV/ HIV co-infected individuals.

Current Status of Microsporidium Among Hospitalised Human Immunodeficiency Virus (HIV/AIDS) Infected Patients, Federal Medical Centre, Keffi, Nigeria

Current Status of Microsporidium Among Hospitalised Human Immunodeficiency Virus (HIV/AIDS) Infected Patients, Federal Medical Centre, Keffi, Nigeria

Newly diagnosed type 1 diabetes mellitus in a human immunodeficiency virus-infected patient with antiretroviral therapy-induced immune reconstitution inflammatory syndrome: a case report

BackgroundDiabetes that develops in human immunodeficiency virus (HIV)-infected patients who receive antiretroviral therapy (ART) is usually type 2 diabetes mellitus (T2DM); however, autoimmune diabetes, such as type 1 diabetes mellitus (T1DM) can also develop in this population. After treatment with ART, patients might experience clinical deterioration following an increase in the CD4 cell count, which is termed immune reconstitution inflammatory syndrome (IRIS). Here, we describe an HIV-infected patient on ART who developed T1DMat due to IRIS, highlighting the clinical complexity in diagnosis and treatment.Case presentationA 36-year-old man infected with HIV had a nadir CD4 cell count of 15.53/μL before medication, which increased to 429.09/μL after 9 months of regular ART. The fasting serum glucose at 9 months was between 96 mg/dL and 117 mg/dL. After 11 months of ART, the patient was admitted to hospital for diabetic ketoacidosis (DKA) and Graves’ disease (GD). Noninsulin antidiabetics (NIADs) were prescribed following the resolution of DKA. However, poor glycemic control was noted despite well-titrated NIADs. Further investigation demonstrated poor pancreatic beta cell function and elevated anti-glutamic acid decarboxylase (anti-GAD) and anti-tyrosine phosphatase-like insulinoma antigen 2 (anti-IA2) titers. According to the results, he was diagnosed with T1DM and received multiple daily injections(MDI) of insulin. The regimen of MDI was insulin degludec as basal insulin and insulin aspart as prandial insulin. After MDI therapy, his glycemic control was improved.ConclusionIn this case, T1DM was ascribed to IRIS. Although this phenomenon has been demonstrated in previous case reports, further study is necessary to realize the mechanism of this association. Therefore, we emphasize that when HIV-infected patients on ART experience an unstable blood glucose level and abnormal thyroid function, physicians should consider T1DM and GD associated with ART-induced IRIS to reduce the subsequent complications and more serious endocrine dysfunction.