Human Immunodeficiency Virus Infected Subjects Research Articles

Comparison of Interferon-γ Release Assays and the Tuberculin Skin Test for Diagnosis of Tuberculosis in Human Immunodeficiency Virus: A Systematic Review.

BackgroundIt remains uncertain if interferon-γ release assays (IGRAs) are superior to the tuberculin skin test (TST) for the diagnosis of active tuberculosis (TB) or latent tuberculosis infection (LTBI) in immunosuppressed populations including people with human immunodeficiency virus (HIV) infection. The purpose of this study was to systematically review the performance of IGRAs and the TST in people with HIV with active TB or LTBI in low and high prevalence TB countries.MethodsWe searched the MEDLINE database from 1966 through to January 2017 for studies that compared results of the TST with either the commercial QuantiFERON-TB Gold in Tube (QFTGT) assay or previous assay versions, the T-SPOT.TB assay or in-house IGRAs. Data were summarized by TB prevalence. Tests for concordance and differences in proportions were undertaken as appropriate. The variation in study methodology was appraised.ResultsThirty-two studies including 4,856 HIV subjects met the search criteria. Fourteen studies compared the tests in subjects with LTBI in low TB prevalence settings. The QFTGT had a similar rate of reactivity to the TST, although the first-generation version of that assay was reactive more commonly. IGRAs were more frequently positive than the TST in HIV infected subjects with active TB. There was considerable study methodology and population heterogeneity, and generally low concordance between tests. Both the TST and IGRAs were affected by CD4 T-cell immunodeficiency.ConclusionOur review of comparative data does not provide robust evidence to support the assertion that the IGRAs are superior to the TST when used in HIV infected subjects to diagnose either active TB or LTBI.

An Efficient, Large-Scale Survey of Hepatitis C Viremia in the Democratic Republic of the Congo Using Dried Blood Spots.

Efficient viral load testing is needed for hepatitis C (HCV) surveillance and diagnosis. HCV viral load testing using dried blood spots (DBSs), made with a single drop of finger-prick whole blood on filter paper, is a promising alternative to traditional serum- or plasma-based approaches. We adapted the Abbott Molecular m2000 instrument for high-throughput HCV viremia testing using DBSs with simple specimen processing and applied these methods to estimate the national burden of infection in the Democratic Republic of the Congo (DRC). We tested DBSs collected during the 2013-2014 DRC Demographic and Health Survey, including 1309 adults ≥40 years of age. HCV-positive samples underwent targeted sequencing, genotyping, and phylogenetic analyses. This high-throughput screening approach reliably identified HCV RNA extracted from DBSs prepared using whole blood, with a 95% limit of detection of 1196 (95% confidence interval [CI], 866-2280) IU/mL for individual 6-mm punches and 494 (95% CI, 372-1228) IU/mL for larger 12-mm punches. Fifteen infections were identified among samples from the DRC Demographic and Health Survey; the weighted country-wide prevalence of HCV viremia was 0.9% (95% CI, 0.3%-1.6%) among adults ≥40 years of age and 0.7% (95% CI, .6%-.8%) among human immunodeficiency virus-infected subjects. All successfully genotyped cases were due to genotype 4 infection. DBS-based HCV testing represents a useful tool for the diagnosis and surveillance of HCV viremia and can easily be incorporated into specimen referral systems. Among adults ≥40 years of age in the DRC, 100000-200000 may have active infection and be eligible for treatment.

Immunosuppressive Acidic Protein- Haematological correlates in HIV infected subjects

Background: Immunosuppressive Acidic protein (IAP) is a marker of the extent of immune defects occurring in most cancers. Its correlation with CD4 cell count used as an indicator of immune function and disease progression in Human Immuno-deficiency Virus (HIV) infection is not well documented.Aims and Objectives: To determine if IAP levels correlates with immunosupression and haematopathology occurring in HIV/AIDS infection.Materials and Methods: This cross sectional study was conducted at the Federal Teaching Hospital, Ido-Ekiti. One hundred and five participants consisting of 85 HIV infected test subjects and 20 control subjects were enrolled into the study. CD4 counts was obtained using SL Cyflow machine, IAP levels determined using ELISA kit for human IAP and Full blood count for all participants was obtained using Sysmex KX-21N Haematology Analyzer. Regression and correlation analysis was done on data using SPSS 28.Results: IAP showed a negative correlation with CD4 count (r= -0.6), (r= -0.9) and (r= -0.2) in the ART, NART and control groups. The pattern of the results was similar with other parameters except in Neutrophils (r= 0.2) (r= 0.3) and (0.1), Eosinophil (r= 0.6) (r= -0.4) and (r= -0.2) and Lymphocyte (r = -0.3) (r= -0.02) and (r= 0.05) in the ART, NART and control groups respectively. CConclusion: The outcome of this study show that a strong negative relationship exist between IAP and other immunohaematological parameters used for monitoring Immune status in HIV infection; however the information gotten is not sufficient to indicate IAP as a predictor of immune status in HIV infection. Further studies are therefore required to better elucidate the mechanism of increased IAP levels at different clinical stages of HIV infection.Asian Journal of Medical Sciences Vol.8(5) 2017 8-16

Prolongation of the QTc interval in HIV-infected individuals compared to the general population.

Prolonged QT interval is associated with arrhythmias and sudden death. An increased prevalence of QT interval prolongation in human immunodeficiency virus-infected (HIV) subjects was previously described. The impact of different medications and HIV infection itself on the QT interval is rarely investigated in large HIV+ cohorts. We compared QT interval measurement in 496 HIV(+) patients of the HIV-HEART study (HIVH) and 992 sex- and age-matched controls of the population-based German Heinz Nixdorf Recall study (HNR). QT corrected for heart rate (QTc) >440ms in male and >460ms in female was considered pathological. We analysed the impact of HIV status and HIV medication on QTc prolongation in the HIVH subjects. We observed longer QTc in HIVH subjects compared with HNR controls: 424.1ms±23.3 vs. 411.3±15.3ms for male and 435.5ms±19.6 vs. 416.4ms±17.3 for female subjects (p<0.0001 for both sexes). Adjusting for QT prolonging medication the mean differences in QTc between the two studies remained significant with 12.6ms (95% CI 10.5-14.8; p value <0.0001) for male and 19.3ms (95% CI 14.5-24.2; p value <0.0001) for female subjects. Prolongation of QTc was pathologic in 22.8 vs. 3.9% of HIV(+) and non-infected males and in 12.1 vs. 1.8% of the females [OR of 7.9 (5.0-12.6) and OR of 6.7 (1.8-24.2), respectively]. Smoking behaviour was an independent factor to lengthen QTc in HIV(+) patients. Diabetes mellitus was not a risk factor itself, but might be associated with medication which was associated with LQT. We could not observe any influence of the HIV status, ART, or any co-medication on the QTc. Our study showed that HIV(+) patients had significantly longer QTc intervals compared to the general population. The number of patients with pathologic QTc prolongation was significantly increased in HIV(+) population.

Performance of urinalysis tests in screening for significant bacteriuria among human immunodeficiency virus-infected subjects in South India.

Performance of urinalysis tests in screening for significant bacteriuria among human immunodeficiency virus-infected subjects in South India.

Variable Influencing Parameters of Different Levels of Immunosuppression in HAART-naive HIV Subjects in Nigeria

Background and Objectives: Varying degrees of immunosuppression may be observed in human immunodeficiency virus (HIV) infected subjects. This study sought to evaluate the factors which might influence different levels of immunosuppression in this group of subjects. Methodology: Immunosuppression, defined as CD4<500 cells/ml, was evaluated in treatment-naive HIV subjects. Body mass index (BMI), 24 h urine creatinine (24HUCr), 24 h urine protein (24HUP), creatinine clearance (ClCr), hemoglobin (Hb) and CD4 cells count were determined and the data compared among the subjects who have different levels of immunosuppression, defined here as mild for CD4 350-499 cells/ml, moderate for CD4 200-349 cells/ml and severe for CD4<200 cells/ml. Results: CD4 cells count 200-349/ml was prevalent in 31.3%, CD4 350-499/ml in 25.4% and CD4 ≥ 500 cells/ml in 122(31.0%) of the HIV subjects. Immunosuppression was significantly associated with BMI (df=9, p=0.008), 24HUCr (df=6, p=0.019) and anemia (df=9, p<0.001). None of these three variables, in addition to 24HUP, was a predictor of moderate immunosuppression (CD4 cells count 200-349/ml). However, BMI, ClCr, 24HUP and Hb were predictors of mild immunosuppression (CD4 350-499 cells/ml) (p=0.006, p=0.008, p=0.026 and p=0.003 respectively). Conclusion: Variable levels of immunosuppression were prevalent in this study. Anemia, abnormal weight and renal damage were common but variable in subjects who have different levels of immunosuppression in the early stage of HIV infection.

136-78: PROLONGATION OF THE QTc INTERVAL IN HIV INFECTED INDIVIDUALS COMPARED TO THE GENERAL POPULATION

Background: A prolongation of the QT interval is a well known marker for the risk for polymorphous ventricular tachycardia such as torsade de pointes and sudden arrhythmic cardiac death (SCD). An increased prevalence and correlation of QT interval prolongation in human immunodeficiency virus infected (HIV) subjects was previously described in various occasions, when compared with HIV-uninfected subjects. The impact of different medications and HIV-infection itself on the electrical activity of the heart is rarely investigated in large HIV+ cohorts. Methods: We compared QTc measurement in 496 HIV-infected patients of the HIV-HEART study (HIVH) and 992 sex- and age-matched controls of the population-based Heinz Nixdorf Recall study, both recruited from the German Ruhr area since 2000. A 12-lead ECG was performed in all participants. ECG were interpreted automatically using the integrated 12SL-Code. The QT was corrected for heart rate using Bazett's formula (QTc = QT/√RR). Data were analysed by use of gender-specific QTc categories (men: abnormal > 440 ms and women: abnormal > 460 ms). Current medication was determined by personal interview and manually coded into Anatomical Therapeutic Chemical (ATC) codes. Based on the literature we defined QT prolonging medication (QT-PM) Results: We observed longer QTc in HIVH subjects compared with HNR controls: 424 ± 23 ms vs. 411 ± 15 ms for male and 435 ± 20 ms vs. 416 ± 17 ms for female subjects (p < 0.0001 for both sexes). HIVH males used QT-PM more often (22.3% vs 17.6% for HNR) than HIVH females (13.3% vs 24.7% for HNR). However, adjusting for QT-PM the mean differences in QTc remained significant with 13 ms (95%CI: 11;15) for male and 19 ms (95%CI: 14;24) for female subjects. Prolongation of QTc was pathologic in 22.8% vs. 3.9% of HIVH and HNR males and in 12.1% vs. 1.8% of the females (OR of 7.9 (5.0;12.6) and OR of 6.7 (1.8;24.2), respectively). We analysed the possible role of HIV status and HIV medication on QTc prolongation in the subgroup of the cohort with HIV infection. There was no significant correlation between the clinical or immunological status and QTc interval for patients infected with HIV. No class of HIV medications was significantly associated with QTc prolongation, nor was the overall number of prescribed medications per patient. Conclusions: Our study established that HIV+ patients have slightly but significantly longer QTc intervals compared to the general population. This translates into a higher proportion of patients with a pathologic QTc interval in our study. When prescribing drugs other than antiretroviral therapy to HIV-infected patients clinicans should thoroughly consider possible QT prolonging effects of these drugs. However, whether the increased QTc interval in HIV-infected patients leads to a higher proportion of arrhythmias and cardiac events in HIV+ compared to the general population remains unclear. Therefore, further prospective studies are needed.

Increased Cortical Cerebral Blood Flow in Asymptomatic Human Immunodeficiency Virus-Infected Subjects

Human immunodeficiency virus (HIV)-infected individuals are at high risk for ischemic stroke. To investigate the physiological basis for this risk, we used magnetic resonance imaging (MRI) to measure oxygen extraction fraction (OEF) and cerebral blood flow (CBF) in treatment-naive asymptomatic HIV-infected subjects and controls. In treatment-naive asymptomatic HIV-infected subjects and age-, gender-, and race-matched controls, OEF was measured by MRI asymmetric spin-echo echo-planar imaging sequences and CBF was measured by MRI pseudocontinuous arterial spin labeling. Twenty-six treatment-naive HIV-infected subjects and 27 age-, gender-, race-matched controls participated. Whole-brain, gray matter (GM), and white matter OEF were not different between the groups (all P > .70). Unexpectedly, HIV-infected subjects had significantly higher CBF in cortical GM (72.9 ± 16.2 mL/100 g/min versus 63.9 ± 9.9 mL/100 g/min; P = .01) but not in subcortical GM (P = .25). The observed increase in cortical GM CBF in treatment-naive HIV-infected subjects is unexpected, contrary to CBF decreases reported in HIV-infected subjects on treatment, and may represent an initial increase in metabolic activity due to an HIV-mediated inflammation.

Increased Cortical Cerebral Blood Flow in Asymptomatic Human Immunodeficiency Virus-Infected Subjects

Increased Cortical Cerebral Blood Flow in Asymptomatic Human Immunodeficiency Virus-Infected Subjects

Evaluating the use of procalcitonin in an asymptomatic, HIV-infected antiretroviral therapy-naïve, South African cohort.

The chronic stage of human immunodeficiency virus (HIV) infection, although clinically asymptomatic, is characterized by activation of the immune system and persistent inflammation. Procalcitonin (PCT) has been studied in HIV infection as a marker of bacterial infection. Our aim was to assess the effect of persistent immune activation on PCT levels in asymptomatic treatment naïve HIV infected subjects. This was a cross-sectional study of 68 asymptomatic antiretroviral therapy-naive HIV infected participants and 42 uninfected controls. Stored serum samples were used to measure: PCT, interleukin-6 (IL-6), lipopolysaccharide binding protein (LBP), high sensitivity C-reactive protein (hsCRP), immunoglobulin G (IgG) and albumin. PCT was correlated with markers of: disease progression (CD4 count and viral load), immune activation (CD 38 on CD8+ T cells, IgG and LBP), inflammation (IL-6, hsCRP and albumin). IL-6, IgG and CD8/38 were all significantly increased while albumin and CD4 counts were significantly lower in the HIV infected group. PCT levels were not significantly different between the two groups. There was no significant difference in LBP and hsCRP; however, their levels were increased in both groups. PCT correlated only with LBP (p=0.0001). IL-6 and LBP correlated positively with hsCRP and IgG. Albumin correlated inversely with IL-6 and viral load. Only IgG and CD8/38 correlated inversely with CD4 counts. We demonstrated the activation of the innate (raised LBP), humoral (raised IgG) and cellular immune systems (increased CD8/38 T cells). Despite a state of persistent inflammation, PCT levels are not elevated in asymptomatic untreated HIV infection.

Hepatitis B and C Co-Infections in Some HIV-Positive Populations in Cameroon, West Central Africa: Analysis of Samples Collected Over More Than a Decade.

As people infected with the human immunodeficiency virus (HIV) in Sub-Saharan Africa live longer due to availability of antiretroviral treatment (ART), so is the rise of associated infections with their burdens on patients. But reliable data on the prevalence of co-infection with hepatitis B (HBV) or C (HCV) still remains sparse and many individuals with HIV do not know their co-infection status. This study attempted to estimate the seroprevalence and identify risk factors associated with hepatitis B and/or C co-infections in HIV-infected individuals from five Regions of Cameroon by screening 531 HIV infected subjects for the presence of HBV surface antigen (HBsAg) and antibodies to HCV (HCV-Ab). A Screening and a confirmatory Enzyme linked immunosorbent assay were used to detect presence of markers of infection. CD4 count levels were also examined. The results indicate that of the 531 participants, 68% were females and 32% males. Mean CD4 count was ~400 cells/μl. Seroprevalence rates for HBsAg and HCV-Ab were 23.7%, and 7.2%, respectively. Associations assessed using logistic regression revealed that HBsAg but not HCV-Ab positivity was linked to age, lower CD4 count and residing in an urban rather than in a rural setting. This high prevalence of co-infection with HBV raises the urgent need to systematically screen all newly diagnosed HIV cases for co-infection in Cameroon and other regions of sub-Saharan Africa where HIV accounts for the majority of the global infection, so as to improve management strategies for HBV infection and ART implementation.

Effect of isoniazid preventive therapy on tuberculosis or death in persons with HIV: a retrospective cohort study.

BackgroundIsoniazid preventive therapy (IPT) is a recommended strategy for prevention of tuberculosis (TB) in persons with Human Immunodeficiency Virus (HIV) although the benefits have not been unequivocally demonstrated in routine clinical practice with widespread ART adoption. Therefore, we assessed the effectiveness of IPT in prevention of TB or death in patients treated with antiretroviral therapy (ART) in a chronic care setting.MethodsRetrospective cohort study of HIV patients enrolled in chronic care from 2007 to 2013. Eligible participants were HIV infected subjects (age > 15 years) with no (history of) TB. The combined effect of IPT and ART on the composite outcome (TB or death) was estimated using time-dependent Cox regression with adjustment for baseline covariates.Results1,922 patients were included, 374 (19.4 %) received IPT and 258 (13.4 %) developed TB or deceased. The median follow-up duration of the cohort was 839 days, with a total of 5491 person years. In unadjusted analysis, the combination of IPT and ART lowered the hazard of TB or death by 65 % [HR = 0.35; 95 % CI (0.16, 0.77)] compared to ART alone. Even after adjustment for confounders, the combined effect of ART and IPT resulted in a 60 % hazard reduction of TB or death in comparison to participants who received ART without IPT [HR = 0.40; 95 % CI (0.18, 0.87)]. The IPT-specific benefit in patients not receiving ART could not be reliably estimated due to high rates of ART adoption.ConclusionThe combined effect of IPT and ART to prevent TB or death in HIV patients in a non-experimental setting in comparison to ART alone was estimated to be 60 %.

Peru-15 (Choleragarde®), a live attenuated oral cholera vaccine, is safe and immunogenic in human immunodeficiency virus (HIV)-seropositive adults in Thailand

BackgroundMany areas with endemic and epidemic cholera report significant levels of HIV transmission. According to the World Health Organization (WHO), over 95% of reported cholera cases occur in Africa, which also accounts for nearly 70% of people living with HIV/AIDS globally. Peru-15, a promising single dose live attenuated oral cholera vaccine (LA-OCV), was previously found to be safe and immunogenic in cholera endemic areas. However, no data on the vaccine's safety among HIV-seropositive adults had been collected. MethodsThis study was a double-blinded, individually randomized, placebo-controlled trial enrolling HIV-seropositive adults, 18–45 years of age, conducted in Bangkok, Thailand, to assess the safety of Peru-15 in a HIV-seropositive cohort. Results32 HIV infected subjects were randomized to receive either a single oral dose of the Peru-15 vaccine with a buffer or a placebo (buffer only). No serious adverse events were reported during the follow-up period in either group. The geometric mean fold (GMF) rise in V. cholerae O1 El Tor specific antibody titers between baseline and 7 days after dosing was 32.0 (p<0.001) in the vaccine group compared to 1.6 (p<0.14) in the placebo group. Among the 16 vaccinees,14 vaccinees (87.5%) had seroconversion compared to 1 of 16 placebo recipients (6.3%). V. cholerae was isolated from the stool of one vaccinee, and found to be genetically identical to the Peru-15 vaccine strain. There were no significant changes in HIV viral load or CD4 T-cell counts between vaccine and placebo groups. ConclusionPeru-15 was shown to be safe and immunogenic in HIV-seropositive Thai adults.

Abstract W P399: Magnetic Resonance Imaging Based Cerebral Blood Flow Changes in Asymptomatic Human Immunodeficiency Virus Infected Subjects

Background: Human Immunodeficiency Virus (HIV) infected individuals are at high risk for ischemic stroke. Magnetic resonance imaging (MRI) method of measurement of cerebral blood flow (CBF) and oxygen extraction fraction (OEF) may help assess the stroke risk in asymptomatic HIV subjects. Objectives: To evaluate MR measured CBF and OEF in treatment naïve asymptomatic HIV+ subjects and HIV- controls. Methods: Treatment naïve asymptomatic HIV+ subjects and age-gender-race matched HIV- controls were assessed for CBF using a pulsed arterial spin labeling (PASL) approach and Oxygen Extraction Fraction (OEF) using MRI T2*-weighted echo-planar imaging (EPI) sequences. All images were acquired using a Siemens 3T MR scanner (Treo, Siemens Medical Systems Inc). Quantitative CBF and OEF measurements were made in the whole-brain, gray matter and white matter and compared between the groups using unpaired t-test. Results: A total of 65 subjects of who, 35 treatment naïve HIV+ subjects (Mean age ± SD=30±7,89% male, 31% white, 49% black and 20% others) and 30 age-gender-race matched HIV- controls (Mean age± SD= 31±8,93% male, 37% white, 53% black and 10% others) consented to the protocol. HIV+ subjects compared to HIV- controls had significantly higher whole brain CBF (58.0 ± 13.8 ml/100g/min vs. 51.3 ± 9.0 ml/100g/min; p=0.03) and gray matter CBF (72.9 ± 16.2 ml/100g/min vs. 63.9 ± 9.9 ml/100g/min; p=0.01). However, values for whole brain OEF (0.4 ± 0.04) and gray matter OEF (0.4 ± 0.05) were similar for both groups. White matter CBF in HIV+ subjects (41.5 ± 13.1 ml/100g/min) compared to HIV- controls (37.2 ± 9.2 ml/100g/min) was not significantly higher (p=0.16) while white matter OEF (0.4 ± 0.04 HIV+ subjects vs. 0.4 ± 0.03 HIV-controls) showed no changes. Conclusions: The observed increase of whole brain CBF in treatment naïve HIV + subjects compared to HIV- matched controls, without corresponding changes in the OEF appears to be driven by a pronounced significant change in the gray matter compared with the white matter. These changes in CBF without corresponding changes in OEF suggest increase in metabolic activity, and may explain the higher stroke risk in asymptomatic HIV subjects.

IFNL4 ss469415590 polymorphism is associated with unfavourable clinical and immunological status in HIV-infected individuals

The IFNL4 ss469415590 polymorphism, in high linkage disequilibrium with the IL28B rs12979860 variant, has been associated with hepatitis C virus clearance. We evaluated whether ss469415590 is associated with clinical and immunovirological parameters in human immunodeficiency virus-infected subjects. We found an independent association of the IFNL4 ss469415590 polymorphism with higher prevalence of AIDS-defining illnesses and lower CD4 T cell numbers. These results suggest the existence of common host defence mechanisms against different viral infections.

Characteristics of HCV Co-Infection among HIV Infected Individuals from an Area with High Risk of Blood-Borne Infections in Central China

ObjectiveHepatitis C virus (HCV) and human immunodeficiency virus (HIV) co-infection has been proved to be a growing public health concern. The prevalence and genotypic pattern vary with geographic locations. Limited information is available to date with regard to HCV genotype and its clinical implications among those former commercial blood donor communities. The aims of this study were to genetically define the HCV genotype and associated clinical characteristics of HIV/HCV co-infected patients from a region with commercial blood donation history in central China.MethodsA cross sectional study, including 164 HIV infected subjects, was conducted in Shanxi province central China. Serum samples were collected and HCV antibody testing, AST and ALT testing were performed. Seropositive samples were further subjected to RT-PCR followed by direct sequence coupled with phylogenetic analysis of Core-E1 and NS5B regions performed in comparison with known reference genotypes.FindingsA total of 139 subjects were HCV antibody positive. Genotype could be determined for 88 isolates. Phylogenetic analysis revealed that the predominant circulating subtype was HCV 1b (65.9%), followed by HCV 2a (34.1%). The HCV viral load in the subjects infected with HIV1b was significantly higher than those infected with HCV 2a (P = 0.006). No significant difference for HCV RNA level was detected between ART status, CD4+ cell count level and HIV RNA level. Serum AST and ALT level were likely to increase with HCV RNA level, although no significance was observed. Those who had conducted commercial donation later than 1991 (OR 3.43, 95% CI: 1.12–10.48) and had a short duration of donation (OR 0.35, 95% CI: 0.13–0.96) were more likely to be infected with HCV 1b.ConclusionThese results suggest that HCV subtype 1b predominates in this population, and the impact of HIV status and ART on HCV disease progression is not significantly correlated.

Lung Microbiome for Clinicians. New Discoveries about Bugs in Healthy and Diseased Lungs

Microbes are readily cultured from epithelial surfaces of the skin, mouth, and colon. In the last 10 years, culture-independent DNA-based techniques demonstrated that much more complex microbial communities reside on most epithelial surfaces; this includes the lower airways, where bacterial culture had failed to reliably demonstrate resident bacteria. Exposure to a diverse bacterial environment is important for adequate immunological development. The most common microbes found in the lower airways are also found in the upper airways. Increasing abundance of oral characteristic taxa is associated with increased inflammatory cells and exhaled nitric oxide, suggesting that the airway microbiome induces an immunological response in the lung. Furthermore, rhinovirus infection leads to outgrowth of Haemophilus in patients with chronic obstructive pulmonary disease, and human immunodeficiency virus-infected subjects have more Tropheryma whipplei in the lower airway, suggesting a bidirectional interaction in which the host immune defenses also influence the microbial niche. Quantitative and/or qualitative changes in the lung microbiome may be relevant for disease progression and exacerbations in a number of pulmonary diseases. Future investigations with longitudinal follow-up to understand the dynamics of the lung microbiome may lead to the development of new therapeutic targets.

Prevalence and Risk Factors for Hepatitis C and Human Immunodeficiency Virus Coinfection among Children in Enugu, Nigeria

Hepatitis C virus (HCV) and Human Immunodeficiency virus (HIV), are major public health challenges in the developing world especially sub-Saharan Africa. The aim of this study was to determine the prevalence and risk factors of Hepatitis C virus infection among children infected with HIV. This was a cross-sectional study conducted at the Paediatric HIV Clinic, UNTH, Enugu between July and December 2009. Antibodies to HCV were analyzed by newer generation rapid chromatographic immunoassay method using the Chromatest one step HCV test kit. The data was analysed using the Statistical Package for Social Sciences (SPSS) version 15 statistical software. The chi squared test was used to test for significant association of categorical variables. A p-value of <0.05 was accepted as significant. One hundred and eighteen children HIV-infected children, aged between eighteen months to fifteen years were included in the data analysis. Eight of the HIV infected subjects were positive for HCV, giving an HIV-HCV co-infection prevalence of 6.8%. Co-infection was more prevalent among males and in those in age group 11-15 years. Blood transfusion, irrespective of frequency (p<0.015), and injections for immunization (p<0.049) were the significant risk factors noted. There is need for strengthening of existing preventive strategies against HCV and HIV infections such as screening of donor blood and safe injection practices in our locality.

Sa1515 Should We Keep HIV Infected Patients in the Average-Risk Screening Category? a Sub-Analysis of the Comp (Colonoscopy Outcomes in Minority Population) Registry Data

Should We Keep HIV Infected Patients in the Average-Risk Screening Category? a Sub-Analysis of the Comp (Colonoscopy Outcomes in Minority Population) Registry Data Manhal Olaywi*, Shashideep Singhal, Kinesh Changela, Deepanshu Jain, Devin Lane, Mojdeh Momeni, Mahesh Krishnaiah, Sushil Duddempudi, Sury Anand Gastorenterology, The Brooklyn Hospital Center, Brooklyn, NY Introduction: Human Immunodeficiency Virus (HIV) infected patients have altered immune system and host defenses that affect their predisposition to cancers. There is limited literature to elucidate the effect of HIV on colorectal carcinogenesis and precancerous colonic adenomas. The analysis was targeted to determine the differences in development of colonic adenomas in HIV infected subjects in comparison to general population. Methods: The subjects with HIV were selected from the COMP registry at our institution using ICD 9 code. Subjects presenting for screening colonoscopy age 50 to 75 years were included, while colonoscopies done for evaluation of symptoms or surveillance of prior malignancy were excluded. The demographic, clinical, and pathological data of study subjects were analyzed using SPSS statistical software to compare HIV positive and control group. Results: A total of 1775 colonoscopies met the inclusion criteria with 115 subjects who were identified as HIV positive and 1660 in control group. Racial distribution was African Americans 58%, Hispanics 32% and 10% others. There was a predominance of males in the HIV group 60% in comparison to control group 40% (p 0.01). There were no other significant differences in demographics of HIV group in comparison to controls. A significantly higher proportion of HIV patients had poor bowel preparation 14.8% in comparison to control group 9.5% (p 0.05), hence were excluded from the analysis to exclude the confounding effect. The adenoma detection rate (ADR) for the HIV group 13% was lower 13% in comparison to the controls 23.6% (P 0.001). The advanced adenoma detection rate (AaDR) was also lower in the HIV group 7.8%, while it was 14% in the control group (P 0.03). On a multivariate analysis HIV positivity was independently associated with lower ADR and AaDR. Conclusion: In our study, the prevalence of pre-malignant colonic adenomas and advanced adenomas in HIV-infected patients was lower than the HIV negative patients. These data support the current practice of screening HIV-infected according to the average-risk screening guidelines.

Does first line antiretroviral therapy increase the prevalence of cardiovascular risk factors in Indian patients?

Antiretroviral therapy (ART) is associated with a myriad of metabolic complications which are potential cardiovascular risk factors. Early detection of these risk factors could help in alleviating morbidity and mortality in human immunodeficiency virus (HIV) infected patients on ART. To study the prevalence of cardiovascular risk factors in patients on a combination of nucleoside reverse transcriptase inhibitors (NRTIs) and non-NRTIs (NNRTIs) - the standard combination first line ART regimen used in tertiary referral center. The prevalence of cardiovascular risk factors in HIV infected subjects with stage 1t disease on standard first line ART for at least 1 year, HIV infected subjects with stage 1 disease and not on ART and HIV negative subjects was assessed. The study was a cross-sectional study design. Basic demographic data was collected and patients were examined for anthropometric data and blood was collected for analysis of blood glucose, serum lipids, and fasting insulin levels. Chi-square test was used to calculate significance. Statistical Package for Social Sciences (SPSS) software version 16.0 was used for data analysis. The prevalence of hypercholesterolemia and hypertriglyceridemia was higher in the patients on ART when compared to patients not on ART (P<0.001). There was no difference in the prevalence of abnormal glycemic status, obesity, abdominal obesity, insulin resistance, and hyperinsulinemia between patients on ART and those not on ART. First line ART is associated with increased prevalence of dyslipidemia. Early detection and treatment of dyslipidemia should help in reducing the cardiovascular morbidity in patients on ART.