Human Immunodeficiency Virus Infected Persons Research Articles

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 (< 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 <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 < 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.

The pattern and magnitude of T cell subsets reconstitution during ten years of ART with viral suppression in HIV-infected patients

The extent of immune reconstitution in human immunodeficiency virus (HIV) infected persons receiving long-term antiretroviral therapy (ART) with controlled viral load has been controversial. We studied the extent and speed of T cell subsets retrieval after long-term antiretroviral treatment. 662 HIV-infected patients followed at least 2 years whose plasma HIV-1 RNA load <50 copies/mL were evaluated for longitudinal and functional phenotypic indices of immune restoration. Determinants of change in magnitude and importance of recovery have been evaluated using mixed linear regression models. Almost all robust immune restorations achieved occurred after 2-3 years of ART. The median CD4 lymphocyte count increased 449 cells/μl (IQR 303-604) from 226 cells/μl (IQR 83-336) at baseline during the third year (P < 0.001); CD4+T lymphocyte rises during the sixth and tenth years were not significant. Naive and memory CD4+T cells'reconstitution occurred in the sixth and eighth years of ART but no significant change thereafter. The change of CD45RA+Naïve and CD45RA-memory CD4+T cell reconstitution is different in baseline CD4+T cell counts <100 cells/μl group and in baseline CD4+T cell counts >100 cells/μl group. Activation antigen expression (CD38 or HLA-DR) on CD8 lymphocytes declined mostly during the first till second year, and after 4 years, activation antigen expression on patient lymphocytes showed no significant change. The proportion of CD4 cells expressing CD28 climbed during the first years and reached normal levels in the second year. Immune restoration was dependent on the capacity of immune system during the first 2-3 year of ART. But the significant change of CD4 and compartments of CD4+T cells could persist until 6-8 years. The pattern of CD38+CD8+, HLA-DR+CD8+, CD28+CD4+ T cells could quickly return to normal level and no significant change after sufficient time of ART. In general, the immune response compared to the baseline status may be the overall effect from the age and time of antiretroviral treatment.

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.

Factors Associated with Virological Failure among Human Immunodeficiency Virus Infected Patients in Haho Health District Hospital, Togo, 2019

The aim of antiretroviral treatment (ART) is to achieve viral load suppression in every Human Immunodeficiency Virus (HIV) infected person. In low- and middle-income countries like Togo, the disparity in accessibility to ART facilities happens to be one of the most causes of lack in follow-up of infected patients, exposing them to ART failure. This study aims at describing the epidemiological profile of ART outcome and its associated factors in a context of low accessibility to viral load testing facilities in Haho health district in Togo. A cross sectional descriptive and analytical study using a questionnaire filled by reviewing patient's files, was conducted from January to December 2019. The study included all the HIV-positive patients that came for their routine check-up and have been assessed for viral load and have their laboratory results out during this period. The results showed a prevalence of 28.5% of virological failure among patients under ART in Haho health district. The independent associated factors found were not living in couple (AOR=3.4; CI=[1.6-7.3]; p=0.002), not being adherent to ART (AOR=2.8; CI= [1.2-6.4]; p=0.015), being under ART for four years and less (AOR=2.4; CI= [1.1-5.3]; p=0.037) and having 50 years and less (AOR=6.4; CI=[1.4-30.2]; p=0.019). Healthcare practitioners implicated in the follow-up of HIV infected patients under treatment need to develop new strategies like reinforcing adherence to ART through communication, to improve outcome at an early stage.

Evaluation of tenofovir disoproxil fumarate loaded silver nanoparticle on testicular morphology in experimental type-2 diabetic rats

Reproductive derangement and metabolic disorders in human immunodeficiency virus (HIV) infected persons require a nanoparticle delivery system to convey antiretroviral drugs to the anatomical sanctuary such as testis. This study investigated the effects of tenofovir disoproxil fumarate (TDF) loaded silver nanoparticles (AgNPs) on the testicular oxidative stress, inflammatory cytokines and histology in male diabetic rats. Thirty-six Sprague-Dawley rats weighing 230 ± 20 g were randomly divided into diabetic and non-diabetic groups (n = 18). Diabetes was induced using the fructose-streptozotocin (Frt-STZ) rat model. Both groups were further divided into three (n = 6) and administered distilled water, TDF, or TDF-AgNP. Results obtained with the TDF-AgNP administration showed a significant increase (p < .05) in the reduced glutathione and catalase levels. Tumour necrosis factor-alpha and interleukin 6 were reduced in diabetic rats administered TDF-AgNP. More so, administration of TDF-AgNP to diabetic rats improved testicular histoarchitecture in diabetic rats. In addition, diabetic rats administered TDF-AgNP showed a significant reduction (p < .05) in blood glucose levels. TDF-AgNP to diabetic rats enhanced testicular antioxidant enzyme, reduced testicular inflammation, and alleviated structural derangements in the testis. Thus, the application of AgNP to deliver TDF may alleviate testicular toxicity and subsequently cater for neglected reproductive dysfunction during the management of HIV infection.

Зміни імунологічного статусу у ВІЛ-інфікованих осіб із хронічною токсоплазмозною інвазією та токсоплазмозним енцефалітом

Актуальність. Інвазія Toxoplasma gondii у ВІЛ-інфікованих осіб може призвести до поглибленої імунопатології, що сприяє реактивації брадизоїтів та розвитку тяжких опортуністичних захворювань. Мета дослідження: вивчити особливості імунологічного статусу ВІЛ-інфікованих пацієнтів, які інвазовані токсоплазмами, та визначити предиктори розвитку токсоплазмозу мозку. Матеріали та методи. Обстежено 61 ВІЛ-інфіковану особу (33 особи серопозитивні на токсоплазмоз і 28 — серонегативні). Застосовували імуноферментний метод для визначення титрів специфічних протитоксоплазмозних IgG та IgМ; загальних IgM, IgA, IgG, а також IL-2, -4, -10, INF-γ, TNF-2α. Статистичну обробку здійснювали в статистичному пакеті програми Exсel з використанням t-критерію Стьюдента, а також z-критерію Фішера. Методом Байєса та послідовного статистичного аналізу А. Вальда визначали діагностичну цінність окремих лабораторних показників. Результати. У ВІЛ-інфікованих осіб виявлено дисбаланс цитокінів порівняно зі здоровими особами. У серонегативних на токсоплазмоз пацієнтів були підвищені рівні IL-4 (1,57 ± 0,30 пг/мл проти 0,81 ± 0,09 пг/мл, р &lt; 0,001), IL-10 (9,81 ± 0,17 пг/мл проти 6,70 ± 0,13 пг/мл, р &lt; 0,001), ТNF-2α (2,89 ± 0,08 пг/мл проти 1,90 ± 0,04 пг/мл, р &lt; 0,001), INF-γ (9,30 ± 0,47 пг/мл проти 4,13 ± 0,12 пг/мл, р &lt; 0,001), а також загальний IgG (20,63 ± 0,65 г/л проти 16,30 ± 0,94 г/л, р &lt; 0,001). На відміну від серонегативних осіб у серопозитивних були вищими показники IL-10 (11,88 ± 0,50 пг/мл проти 9,81 ± 0,17 пг/мл, р &lt; 0,05) та INF-γ (10,75 ± 0,44 пг/мл проти 9,30 ± 0,47 пг/мл, р &lt; 0,05). Поєднання 2 ознак — INF-γ &lt; 8,8 пг/мл та IL-4 &lt; 0,77 пг/мл чи INF-γ &lt; 8,8 пг/мл та IL-10 &gt; 11,8 пг/мл або 3 ознак — IL-4 &lt; 0,77 пг/мл, IL-10 &gt; 11,8 пг/мл та IL-2 &lt; 1,5 пг/мл є предиктором розвитку токсоплазмозного енцефаліту. Висновки. Установлено, що у ВІЛ-інфікованих осіб відмічаються підвищені рівні деяких прозапальних (TNF-α, INF-γ) та протизапальних (IL-4, -10) цитокінів, але порівняно із серонегативними в серопозитивних на токсоплазмоз осіб переважають показники INF-γ і IL-10. Проявом поглибленої імунопатології та предиктором розвитку токсоплазмозного енцефаліту є зниження рівня INF-γ, IL-4, -2 із підвищенням рівня IL-10 у контингенті серопозитивних на токсоплазмоз осіб.

An Overview of the Cure of HIV/AIDS Harbal Therapy Containing Natural Antioxidant, Vitamins and Minerals

Purposes: The unprecedented and sequence through which an estimate of 25 million lives have gone to their early grave yard through Acquired Immune-deficiency Syndrome HIV/AIDS can never be quantified; since, when it was first describes in 1981. In 2017/2018 by (UNAIDS) it was estimated globally for about 36.9millions people were living with Human, Immunodeficiency Virus (HIV) so to say. Henceforth the progress made in the field of treatment in the form of Antiretroviral Therapy (ART) disease has not been fully ascertain for the cure of HIV/AIDS; except, perpetual clinical suppressions. Thus, the current challenges that man kinds faces with the used of perpetual intake of antiretroviral therapy (clinical suppression)/artificial vaccine is un-justifiable. However, search for HIV therapy have open a new chapter in the search for novel drugs from Kaduna Polytechnic procedure. This review focuses on vitamins, antioxidant, mineral and supplement as sources of in-hibitors or eradications for human immunodeficiency virus type-1 (HIV) reverse transcriptase. Objective: To assess whether vitamins, antioxidant, minerals supplement are effective and safe in eradicating mortality and morbidity among populace with HIV infection. Selection criteria: Randomized control trials were selected that compared the effect of vitamins (A, C, D, E, K,), antioxidant, minerals and supplement with regard to treatment measures in HIV infected persons. Methods: To prevent authors bias, based on a systematic search of literature; anti-HIV reverse transcriptase activity of some plant’s species like those of Eucalyptus leaves, Garlic fresh fruits, Baobab leaves, aloe vera, neem leaves, moringa leaves, bitter leaves etc. respectively. Thus, these medicinal plants contain an appreciable or above values antioxidant compound or photochemical like those of Phenolic, anthraquinone, tannin, falconoid, terpenoid, lignin, coumarins etc. respectively. Contrarywise, these phytochemical compounds have been exploited traditionally for the cure of many diseases as well as inhibition of viral replication/transcription. Further investigations have shared more light through which phytochemicals compounds inhibit virus replication either during the viral entry inside the host cell or during their replication. Originality: in view of the current investigation or to accelerate drug discovery and innovation, this review recommends the urgent need to tap into the enrich locally available endogenous knowledge of putative anti- HIV/AIDS, photochemical and their derivatives, (reverse pharmacology, determine pan assay, interferences compounds, microbial enzyme metabolites relationship and their mechanisms to treat virial diseases.

Co-existence of Herpes simplex virus type 2 and two other oncoviruses is associated with cervical lesions in women living with HIV in South-Western Nigeria.

The prevalence of Herpes simplex virus type 2 (HSV-2) in cervical lesions is under-reported, especially in Human immunodeficiency virus (HIV), Epstein-Barr virus (EBV) and Human Papillomavirus (HPV) infected persons. This study determined the prevalence of viral mono-infections, co-infections and squamous cell intraepithelial lesions (SIL) in HIV seropositive (HIV+) and HIV seronegative (HIV-) women. This study included HIV+ and HIV- women (105 each). Cervical smears and viral antibodies were evaluated by Papanicolaou's technique and ELISA method, respectively. The prevalence of HSV-2, HPV and EBV infections, and SIL were higher in HIV+ women (75.2, 41.9, 41 and 32.4%) than in HIV- women (45.7, 26.7, 26.7 and 13.3%) at p< 0.0001, p= 0.029, 0.041 and 0.002, respectively. Higher prevalence of viral mono-infection and tri-infection was observed in HIV+ women (43.8 and 24.8%) than in HIV- women (27.6 and 8.6%) at p= 0.021, and 0.003, respectively. The prevalence of SIL was also higher in HIV+ women with viral mono-infection, bi-infection and tri-infection (15.2, 42.9, and 53.8%) than in HIV- women (6.9, 12.5, and 44.4%) at p= 0.468, 0.041, and 0.711, respectively. This study suggests that the high prevalence of SIL in HIV+ women could be associated with viral co-infections.

Design, Synthesis and In Vitro Biological Evaluation of Pyridine, Thiadazole, Benzimidazole and Acetyl Thiophene Analogues as Anti Tubercular Agents Targeting Enzyme Inh A.

Tuberculosis is a chronic infectious disease that affects one-third of the global population. The emergence of Multi-resistant (MDR) strains and high susceptibility of human immunodeficiency virus (HIV) infected persons to the disease forced to develop novel antituberculosis agents and preferably have a novel mechanism of action as to avoid cross-resistant with other agents. A literature survey indicated that Pyridine, Thiadiazole, Benzimidazole and Acetyl thiophene derivatives exhibit various pharmacological activities, including anti-mycobacterial activity. Thus, a series of Pyridine, Thiadiazole, Benzimidazole and Acetyl thiophene based molecules were designed and docked against crucial mtb enzyme target InhA (Enoyl Acyl Carrier Protein Reductase) Enzyme. The docked molecules were screened against good docking-score and multiple interactions and opted for synthesis. Synthesized molecules were recrystallized to obtain purity. All the purified compounds were characterized by various spectral analyses and evaluated for antimycobacterial activity against tuberculosis H37RV strain by Microplate Alamar Blue Assay (MABA) method. The experimental results showed that Schiff bases of Pyridine (Compounds 'd') and Benzimidazole derivatives (Compounds 'i' ) possess good anti-tubercular activity with an MIC below 1.6 μg /mL. Furthermore, compound 'e' of benzimdazole derivative showed good antitubercular activity with an MIC below 6.25 μg /mL, whereas 2 - acetyl thiopene compounds exhibited moderate antitubercular activity below 50μg/mL. The comparative in vitro and molecular docking study analysis reveals that compared to chalcones of Acetyl thiophene derivatives, Pyridine, Thiadazole and Benzimidazole based Schiff bases exhibited best antitubercular activity.

Treatment success and mortality among adults with tuberculosis in rural eastern Uganda: a retrospective cohort study

BackgroundSuccessful treatment of tuberculosis leads to clinical and public health benefits such as reduction in transmission, complications, and mortality among patients. However, data are limited on treatment outcomes and the associated factors among persons with bacteriologically confirmed pulmonary (BC-PTB) in rural areas of high dual tuberculosis and Human Immunodeficiency Virus (HIV) burden countries such as Uganda. We investigated factors associated with successful treatment of tuberculosis and mortality among adult persons with BC-PTB in rural eastern Uganda.MethodsWe constructed a retrospective cohort of persons with BC-PTB from a routine tuberculosis clinic database in eastern Uganda. We performed bivariate and multivariate analysis. Using a 5% level of significance, we ran a modified Poisson regression analysis to determine factors independently associated with treatment success and mortality rates.ResultsWe retrieved 1123 records for persons with BC-PTB and the treatment outcomes were distributed as follows: 477(42.5%) cured, 323 (28.0%) treatment completed, 17(1.5%) treatment failed, 81(7.2%) died, 89(7.9%) lost to follow-up, and 136(12.1%) not evaluated. Overall, 800 (81.1%) of the 987 persons with BC-PTB that had treatment outcome, were successfully treated. Successful treatment of tuberculosis was less likely to occur among those with HIV infection (Adjusted risk ratio (aRR), 0.88; 95% Confidence Interval (CI), 0.82–0.95), older than 50 years (aRR, 0.89; 95% CI, 0.81–0.97), or male sex (aRR, 0.92; 95% CI, 0.87–0.98). Mortality was associated with HIV infection (aRR, 4.48; 95% CI, 2.95–6.79), older than 50 years (aRR, 2.93; 95% CI, 1.74–4.92), year of enrollment into treatment after 2015 (aRR, 0.80; 95% CI, 0.66–0.97), and Community-Based Directly Observed Therapy Short Course (aRR, 0.26; 95% CI, 0.13–0.50).ConclusionsTreatment success rate among adult persons with BC-PTB in rural eastern Uganda is suboptimal and mortality rate is high. HIV infection and older age reduce chances of treatment success, and increase mortality rate. Older and HIV infected persons with BC-PTB will require special consideration to optimize treatment success rate and reduce mortality rate.

Assessment of liver and renal functions in human immunodeficiency virus-infected persons on highly active antiretroviral therapy: A mixed cohort study.

Indian data on potential hepatorenal toxic effects of highly active antiretroviral therapy (HAART) in HIV/AIDS-affected persons is lacking. To assess hepatorenal abnormalities in HIV-infected persons on HAART in a hospital-based mixed cohort study using concurrent and nonconcurrent data analysis. Hepatorenal function tests, urinalysis and ultrasonogaphy for liver/kidneys (when applicable) were assessed in 400 (men 185; women 215) persons aged 2-84 (mean 47.8) years on HAART. Acute liver toxicity, acute kidney injury and chronic kidney disease were defined depending upon abnormal serum alanine aminotransferase, urea and creatinine levels/clearance as per standard guidelines. The duration of HAART was 1 month to 9 years (mean 3.7 years) with 284 (71%) individuals being on treatment for ≤5years. The major HAART regimens included zidovudine + lamivudine + nevirapine in 175 (43.8%), tenofovir + lamivudine + efavirenz in 174 (43.5%) and zidovudine + lamivudine + efavirenz in 20 (5%) individuals and were associated with grade-1 hepatic dysfunction in 57 (14.3%) individuals, with men aged between 31 and 45 years on antiretroviral therapy for >5 years being mainly affected. Forty two (17.1%) of 246 individuals with anemia and 15 (9.7%) of 154 individuals without anemia showed hepatic dysfunction. None had acute kidney injury, chronic kidney disease or abnormal urinalysis or ultrasonography. In contrast, the pretreatment elevated serum alanine amiotranerase in 99 (22.3%) and blood urea and/or creatinine levels in 16 (4%) individuals decreased significantly post highly active antiretroviral therapy. The study reflects the low frequency of regimen based highly active antiretroviral therapy-associated hepatic or nephrotoxicity despite prolonged use, especially in the absence of other risk factors. Preexisting anemia appears an important risk factor for highly active antiretroviral therapy-induced hepatotoxicity (OR 1.90, Cl 95% CI 1.02-3.57, P = 0.04). Highly active antiretroviral therapy-associated nephrotoxicity was not a significant problem. Study of viral load or other risk factors and potential of each drug for hepatorenal toxicity/dysfunction in HIV affected were not part of the study. A small number of subjects and retrospective analysis of biochemical parameters were other important limitations.

Personal dispositions as predictors of student nurses' prejudice, stereotyping, and discrimination against human immunodeficiency virus-infected persons in Osun State, Nigeria

Background: Human immunodeficiency virus (HIV)/AIDS is a disease that is stigmatized as a result of its origin and outcome. HIV stigma may occur in the form of prejudice, stereotyping, and discrimination, collectively called HIV stigma mechanism. While studies have shown that student nurses are among persons who stigmatize, little is known about the role of their personal dispositions in the stigma process. Objective: This study aimed to examine the role of personal dispositions on their HIV stigma mechanism against HIV-infected persons. Methods: We employed a cross-sectional descriptive design involving 395 students across Osun State, Nigeria, using a modified Health Care Provider HIV/AIDS Stigma Scale instrument. Four personal dispositions (age, study level, HIV knowledge, and perception) serving as the independent variable, were of interest as well as the HIV stigma mechanism (prejudice, stereotyping, and discrimination) serving as the dependent variable in this study. Data were analyzed using mean and multiple linear regression analysis. Results: The mean scores of the categorical variables of knowledge about AIDS and perception of HIV-infected persons, measured on scales of 0–9 and 0–15, revealed moderate knowledge about HIV (5.90 ± 1.26) and negative perception (10.61 ± 2.47). For the dependent variables, the mean scores were 17.97 ± 4.07 for prejudice, 13.84 ± 3.34 for stereotyping, and 10.47 ± 3.22 for discrimination, which indicated that student nurses stigmatized HIV-infected patients. However, the core finding of this study revealed that, of all the predictors of HIV stigma mechanism, perception was the most significant. Conclusions: Personal dispositions are contributory factors to the enactment of HIV stigma mechanism. Future planning for intervention studies to reduce HIV stigma among health profession students should take cognizance of this.

Interatrial blocks prevalence and risk factors for human immunodeficiency virus-infected persons.

BackgroundInteratrial blocks are considered a new important risk factor for atrial fibrillation and cerebrovascular events. Their prevalence and clinical implications have been reported in general population and several subgroups of patients but no data from HIV-infected populations, with a non-negligible prevalence of atrial fibrillation, has been previously reported.MethodsWe conducted a cross-sectional study in a previously enrolled cohort of randomly selected middle-aged HIV-infected patients who attended our hospital and were clinically stable.Patients underwent both a 12-lead rest electrocardiogram and clinical questionnaires while epidemiological, clinical and HIV-related variables were obtained from electronic medical records and interviews with the patients. Electrocardiograms were then analyzed and codified using a standardized form by two trained members of the research team who were blinded to clinical variables.ResultsWe obtained electrocardiograms from 204 patients with a mean age of 55.22 years, 39 patients (19.12%) presented an interatrial block, 9 (4.41%) advanced and 30 (14.71%) partial. Patients with interatrial block had a lower nadir lymphocyte CD4 count (124 vs 198 cells, p = 0.02) while advanced interatrial blocks were associated to older age (62.16 vs. 54.95 years, p = 0.046) and hypertension (77.8% vs. 32.3%, p = 0.009). We did not find differences regarding baseline CD4 lymphocyte count or CD4/CD8 lymphocyte ratio. Clinical variables and functional capacity among patients with or without interatrial block were similar.ConclusionsIn a cohort of clinically stable HIV infected patients the prevalence of interatrial blocks, specially advanced, is high and associated to previously known factors (age, hypertension) and novel ones (nadir CD4 lymphocyte count).

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

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

FACTORS ASSOCIATED WITH HEPATITIS B AND C CO-INFECTION AMONG PEOPLE LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS IN VIETNAM

Background: Human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) are the leading causes of death from infectious diseases. Because of sharing same transmission routes, the co-infection of HIV with HBV or HCV is common. And the co-infections make HIV infected persons have higher morbidity and mortality than those who infected only with HIV. This study aims to investigate factors that may have influence on the co-infections of HBV or HCV among HIV positive individuals.&#x0D; Objective: The goals of this study were to identify factors associated with the co-infection of HBV or HCV among people living with HIV.&#x0D; Methods: Quantitative research method was applied in this study to examine factors associated with HBV or HCV co-infection among HIV infected people. A total of 250 HIV infected individuals in Khanh Hoa province, Vietnam were the sample of this study. It employed the Social Ecological Model (SEM) as a theoretical perspective that focused on multiple levels of factors. Descriptive statistic was used to describe the general characteristics of the respondents. And Binary logistic regression was carried out to measure the influence of factors on the co-infection.&#x0D; Results: The multivariate analysis of this study showed that HIV-HBV co-infection was associated significantly with residents of Nha Trang (OR= 7.179). Regarding HIV-HCV co-infection, being men (OR= 7.617), unemployed (OR= 4.013), a resident of Nha Trang (OR=10.894) and an injecting drug user (OR= 16.688) were risk factors of the co-infection.&#x0D; Conclusions: This study recommended that intervention strategies to prevent HIV-positive individuals from co-infection with either HBV or HCV should focus on altering individuals’ risk behaviors and their socio-economic environments. Also, specific preventing programs should be implemented and focus on unemployed populations, injecting drug users, men in general, as well as people living in particular areas, especially cities having a large number of people living with HIV.

Update From the Advisory Committee on Immunization Practices

The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts, meets 3 times per year to develop recommendations for vaccine use in the United States. The group usually has 15 voting members, each of whom is appointed to a 4-year term. ACIP members and Centers for Disease Control and Prevention staff discuss the epidemiology of vaccine-preventable diseases and vaccine research, effectiveness, safety data, and clinical trial results. Representatives from the American Academy of Pediatrics (Y. A. M. and D. W. K.) and the Pediatric Infectious Diseases Society (S. T. O.) are present as liaisons to the ACIP. The ACIP met February 27 to 28, 2019, to discuss hepatitis A (HepA) vaccination of human immunodeficiency virus-infected persons, pneumococcal vaccination among adults aged 65 years or older, influenza vaccine effectiveness and safety, anthrax vaccination in the setting of a mass exposure, human papillomavirus vaccine, zoster vaccines, and Japanese encephalitis vaccine.

Prevalence and factors associated with dental caries in patients attending an HIV care clinic in Uganda: a cross sectional study

BackgroundChronic Human Immunodeficiency Virus (HIV) infection is associated with reduced saliva flow rate due to infiltration of HIV and proliferation of CD8 lymphocytes in salivary glands. It is unclear whether HIV infection and antiretroviral therapy (ART) increase caries risk. This study aimed to determine the prevalence and factors associated with dental caries in HIV infected adults attending the Mulago Immune Suppression Syndrome (ISS) clinic in Uganda.MethodsA cross-sectional study was conducted among HIV infected persons. Dental examinations were performed by two calibrated dentists using the WHO Radke’s caries classification criteria and reported using the decayed (D), missing (M), filled (F), teeth (DMFT) index. The prevalence and factors associated with dental caries was examined through linear regression analyses.ResultsOverall, 748 participants (females = 491, 65.6%) with a mean age of 39 ± 9.4 years were included in the final analysis; of whom 83.7% had caries (DMFT> 0), with a significantly (p < 0.05) higher prevalence among females 86.6% than males 78.2%. The mean DMFT was 5.9 ± 5.5, with statistically significant differences based on gender (males 4.9 ± 4.8 and females 6.3 ± 5.9, p < 0.05) and duration on ART (< 2 years 4.8 ± 4.4, > 2 years but < 5 years 5.7 ± 5.5, > 5 years 6.6 ± 6.0 p < 0.05). The majority (67.2%) of participants reported brushing their teeth twice or more a day, and sugar intake was not associated with dental caries.ConclusionCaries prevalence is high among HIV infected adults under care. Duration of ART was associated with increased risk and severity of caries. Therefore, we recommend integration of dental care in HIV treatment programs.

Addition of Flucytosine to Fluconazole for the Treatment of Cryptococcal Meningitis in Africa: A Multicountry Cost-effectiveness Analysis.

BackgroundMortality from cryptococcal meningitis remains very high in Africa. In the Advancing Cryptococcal Meningitis Treatment for Africa (ACTA) trial, 2 weeks of fluconazole (FLU) plus flucytosine (5FC) was as effective and less costly than 2 weeks of amphotericin-based regimens. However, many African settings treat with FLU monotherapy, and the cost-effectiveness of adding 5FC to FLU is uncertain.MethodsThe effectiveness and costs of FLU+5FC were taken from ACTA, which included a costing analysis at the Zambian site. The effectiveness of FLU was derived from cohorts of consecutively enrolled patients, managed in respects other than drug therapy, as were participants in ACTA. FLU costs were derived from costs of FLU+5FC in ACTA, by subtracting 5FC drug and monitoring costs. The cost-effectiveness of FLU+5FC vs FLU alone was measured as the incremental cost-effectiveness ratio (ICER). A probabilistic sensitivity analysis assessed uncertainties and a bivariate deterministic sensitivity analysis examined the impact of varying mortality and 5FC drug costs on the ICER.ResultsThe mean costs per patient were US $847 (95% confidence interval [CI] $776–927) for FLU+5FC, and US $628 (95% CI $557–709) for FLU. The 10-week mortality rate was 35.1% (95% CI 28.9–41.7%) with FLU+5FC and 53.8% (95% CI 43.1–64.1%) with FLU. At the current 5FC price of US $1.30 per 500 mg tablet, the ICER of 5FC+FLU versus FLU alone was US $65 (95% CI $28–208) per life-year saved. Reducing the 5FC cost to between US $0.80 and US $0.40 per 500 mg resulted in an ICER between US $44 and US $28 per life-year saved.ConclusionsThe addition of 5FC to FLU is cost-effective for cryptococcal meningitis treatment in Africa and, if made available widely, could substantially reduce mortality rates among human immunodeficiency virus–infected persons in Africa.

Effect of isoniazid preventive therapy on tuberculosis incidence and associated risk factors among HIV infected adults in Tanzania: a retrospective cohort study

BackgroundTuberculosis (TB) continues to be the leading cause of morbidity and mortality among human immunodeficiency virus (HIV) infected individuals in Sub Saharan Africa including Tanzania. Provision of isoniazid preventive therapy (IPT) is one of the public health interventions to reduce the burden of TB among HIV infected persons. However there is limited information about the influence of IPT on TB incidence in Tanzania. This study aimed at ascertaining the effect of IPT on TB incidence and to determine risk factors for TB among HIV positive adults in Dar es Salaam region.MethodsA retrospective cohort study was conducted using secondary data of HIV positive adults receiving care and treatment services in Dar es Salaam region from 2011 to 2014. TB incidence rate among HIV positive adults on IPT was compared to those who were not on IPT during the follow up period. Risk factors for incident TB were estimated using multivariate Cox proportional hazards regression model.ResultsA total of 68,378 HIV positive adults were studied. The median follow up time was 3.4 (IQR = 1.9–3.8) years for patients who ever received IPT and 1.3 (IQR = 0.3–1.3) years among those who never received IPT. A total of 3124 TB cases occurred during 114,926 total person-years of follow up. The overall TB incidence rate was 2.7/100 person-years (95%CI; 2.6–2.8). Patients on IPT had 48% lower TB incidence rate compared to patients who were not on IPT (IRR = 0.52, 95%CI; 0.46–0.59). Factors associated with higher risk for incident TB included; being male (aHR = 1.8, 95% CI; 1.6–2.0), WHO stage III (aHR = 2.7, 95% CI; 2.3–3.3) and IV (aHR = 2.4, 95% CI; 1.9–3.1),being underweight (aHR = 1.7, 95% CI; 1.5–1.9) while overweight (aHR = 0.7, 95% CI; 0.6–0.8), obese (aHR = 0.5, 95% CI; 0.4–0.7), having baseline CD4 cell count between 200 and 350 cells/μl (aHR = 0.7, 95% CI; 0.6–0.8) and CD4 count above 350 cells/μl (aHR = 0.5, 95% CI; 0.4–0.6) were associated with lower risk of developing TB.ConclusionIsoniazid preventive therapy (IPT) has shown to be effective in reducing TB incidence among HIV infected adults in Dar es Salaam. More efforts are needed to increase the provision and coverage of IPT.

Effect of HIV infection on TB treatment outcomes and time to mortality in two urban hospitals in Ghana-a retrospective cohort study.

IntroductionTuberculosis (TB) is currently causing more deaths than Human Immunodeficiency Virus (HIV) globally. Ghana as one of the 30 high burden TB/HIV countries has a high annual TB case-fatality rate of 10%. The study sought to assess the effect of HIV infection on TB treatment outcomes and assess the time to mortality after treatment onset.MethodsWe conducted a review of treatment files of TB patients who were treated from January 2013 to December 2015 in two urban hospitals in the Accra Metropolis. Modified Poisson regression analysis was used to measure the association between HIV infection and TB treatment outcomes. Kaplan-Meier survival estimates were used to plot survival curves.ResultsSeventy-seven percent (83/107) of HIV infected individuals had successful treatment, compared to 91.2% (382/419) treatment success among HIV non-infected individuals. The proportion of HIV-positive individuals who died was 21.5% (23/107) whilst that of HIV-negative individuals was 5.5% (23/419). Being HIV-positive increased the risk of adverse outcome relative to successful outcome by a factor of 2.89(95% CI 1.76-4.74). The total number of deaths recorded within the treatment period was 46; of which 29(63%) occurred within the first two months of TB treatment. The highest mortality rate observed was among HIV infected persons (38.6/1000 person months). Of the 107 TB/HIV co-infected patients, 4(3.7%) initiated ART during TB treatment.ConclusionThe uptake of ART in co-infected individuals in this study was very low. Measures should be put in place to improve ART coverage among persons with TB/HIV co-infection to help reduce mortality.