Human Immunodeficiency Virus Negative Group Research Articles

Paediatric Anogenital Condylomata Acuminata: An assessment of patient characteristics and the need for surgical intervention

BackgroundAnogenital Condylomata Acuminata (AGCA) are caused by Human Papilloma Virus (HPV), which is one of the most common sexually transmitted illnesses in adults. Although commonly seen in the paediatric population, especially in the setting of immunocompromise, literature regarding transmission, viral type and management in this population is scant. The aim of this study was to assess the profile of patients presenting with anogenital warts in light of associated immunocompromise with Human Immunodeficiency Virus (HIV). MethodsThree years of patient records from Chis Hani Baragwanath Academic Hospital were reviewed (January 2017 – December 2019). Information collected included: gender, age of presentation, age at intervention, type and duration of medical treatment, type and number of surgical interventions, HIV status, and histology results. Fisher's and Pearson's test were used to assess correlation between immune status and surgical interventions necessary. ResultsIn the time frame considered, we treated 66 patients with AGCA . The average age was 4 years old (1–14). HIV status was recorded in 30 patients (15 positive and 15 negative). Only one patient out of 66 had a history of sexual abuse. Whilst the proportion of patients who required surgical intervention in the HIV negative and HIV positive groups was equal (2:1), the total number of surgical interventions needed to achieve clearance was significantly more in those with HIV (p = 0.03). ConclusionsHIV positive patients with AGCA require more surgical interventions compared to HIV negative individuals. Further research will be conducted to ascertain the sub-type of HPV infection in this subset of patients and to assess if this impacts follow-up for future malignancy. Further research also needs to be conducted to ascertain whether surgical intervention should be instituted earlier in the treatment protocol for HIV positive children.

Cataract Surgery Outcomes in Human Immunodeficiency Virus Positive Patients at a Tertiary Care Academic Medical Center in the United States

ABSTRACT Purpose: To compare cataract surgery complications and visual outcomes in patients with and without human immunodeficiency virus (HIV). Methods: A retrospective cohort study was conducted on eyes undergoing phacoemulsification cataract surgery at an academic eye center from 1/1/2014 to 8/31/18. Outcomes included best corrected distance visual acuity (CDVA), intraoperative complications, cystoid macular edema (CME), and persistent anterior uveitis (PAU). Binary outcomes were analyzed using logistic regressions with generalized estimating equations. Visual outcomes were analyzed using a linear mixed model. Results: 9756 eyes from 5988 patients were included in the analysis. Of these, 66 eyes from 39 patients were HIV positive (HIV+). HIV+ patients were significantly younger at the time of surgery than HIV negative patients (p < .0001). Among HIV+ patients with available lab data, the mean CD4 count was 697.3 (SD = 335.7), and 48.7% of subjects had an undetectable viral load. Five eyes from three HIV+ patients had a history of cytomegalovirus retinitis (CMVR). Positive HIV status was not associated with increased risk of intraoperative complications. Post-operative CDVA was better in the HIV negative group compared to the HIV+ group but not significantly different (about 20/24 vs. 20/28, p = .0829). Eyes from HIV+ patients were at increased risk of developing PAU after surgery (adjusted OR = 6.04, 95% CI: 2.42–15.1, p = .0001), as well as CME (adjusted OR = 3.25, 95% CI: 1.02–10.4, p = .0470). Conclusions: Eyes from HIV+ patients were at greater risk of developing PAU and clinically significant CME; however, HIV+ patients had similar CDVA after cataract surgery compared to HIV negative patients.

ASSOCIATION OF HIV INFECTION WITH CLINICAL AND LABORATORY CHARACTERISTICS OF SICKLE CELL DISEASE

Sickle cell disease (SCD) is a multisystem disorder characterized by a wide spectrum of clinical manifestations and severity. Studies investigating potential effects of co-morbid human immunodeficiency virus (HIV) and SCD have produced conflicting results, and additional investigations are needed to elucidate whether the interaction between the two disease states might impact both HIV and SCD clinical outcomes. The association of HIV infection with clinical and laboratory characteristics of patients with SCD was assessed. This nested case-control study included individuals with SCD with HIV treated at six Brazilian SCD centers. Clinical and laboratory data were abstracted from medical records. HIV positive participants were compared to age, gender, center, and SCD genotype matched HIV negative participants (ratio 1:4). Individual clinical outcomes as well as a composite outcome of any SCD complication and a composite outcome of any HIV-related complication were compared between the two groups. Fifteen HIV positive participants were included, 12 (80%) alive and 3 (20%) deceased. Most of the HIV positive patients had HbSS (60%; n = 9), 53% (n = 8) were female, and mean age was 30 ± 13 years. The frequency of individual SCD complications of acute chest syndrome/pneumonia, sepsis/bacteremia, pyelonephritis, ischemic stroke, hemorrhagic stroke, abnormal transcranial Doppler (TCD), and pulmonary hypertension was higher in HIV positive participants when compared to HIV negative, although analyzed individually none were statistically significant. HIV positive participants had significantly higher risk of any SCD complication and of a composite HIV-related complication compared to the HIV negative group (HR = 4.6; 95%CI 1.1–19.6; P = 0.04 and HR = 7.7; 95%CI 1.5–40.2; P = 0.02, respectively). There was a non-significant trend towards higher risk of any infections in participants with HIV positive (HR = 3.5; 95%CI 0.92–13.4; P = 0.07). Laboratory parameters levels were not significantly different in individuals with and without HIV. In summary, our study in SCD patients shows that those with HIV have an increased risk of any SCD complication and HIV-related complications, as well as a suggestive but not significantly increased risk of infections.

Role of basic fibroblast growth factor in human immunodeficiency virus associated pre-eclampsia.

Cell signaling is vital to ensure successful trophoblast invasion. This study assessed the level of serum basic fibroblast growth factor (FGF-2) in human immunodeficiency virus (HIV) associated pre-eclampsia (PE). Using a Bio-plex Multiplex Immunoassay, FGF-2 (pg/mL) was analyzed in blood sera collected from 80 pregnant women attending a large regional hospital in Durban, South Africa. Study groups consisted of normotensive and pre-eclamptic pregnant women stratified according to their HIV status. Data analysis was performed using graphpad prism statistics software, version 5.00. In this study, we report a significant decrease of FGF-2 serum level in pre-eclamptic compared to normotensive pregnant women groups (25.38 ± 6.69 pg/mL vs 61.79 ± 11.25 pg/mL), irrespective of their HIV status. Similarly, there was a significant decrease in FGF-2 serum level in HIV positive compared to HIV negative group (33.80 ± 9.62 pg/mL vs 52.15 ± 9.49 pg/mL), irrespective of their pregnancy type. This study demonstrates a downregulation of serum FGF-2 expression in pre-eclamptic compared to normotensive pregnant women. This decline may be responsible for the defective trophoblast invasion and/or to PE severity. The decline in FGF-2 expression in HIV infection is probably due to the effect of HIV Tat protein on angiogenesis.

The role of human immunodeficiency virus in the pathogenesis of vernal keratoconjunctivitis-like disease in adults: A demographic and epidemiological study

Purpose:The purpose was to identify and describe patients with new-onset vernal keratoconjunctivitis-like (VKC-like) disease after puberty.Methods:The study consisted of two parts: a prospective observational descriptive study of patients with new-onset VKC-like disease, and a case-control study to determine the relationship of a CD4 count with VKC-like disease in adults, in the setting of human immunodeficiency virus (HIV). Patients were recruited between January 2016 and November 2017 from a Provincial Eye hospital, one of two large referral hospitals in KwaZulu-Natal, South Africa. Patients presenting to the eye clinic were screened and diagnosed at the Primary Eye Care Unit. Inclusion criteria: age 15 years and older with signs and symptoms of new-onset VKC-like disease. Exclusion criteria: a history of childhood atopic diseases, atopic keratoconjunctivitis and patients who declined HIV testing. Data collected included HIV status, CD4 count, antinuclear antibodies and total serum immunoglobulin E.Results:Thirty-three patients were included; females n = 16 and males n = 17. The mean age at presentation was 32.45 ± 9.93 years, 95% CI = 28.94–35.97. Twenty-six patients (78.8%) were HIV positive, 95% CI (62–89). The proportion of HIV positive patients was statistically different from the HIV negative group, Chi-squared = 21.866, P value <0.0001. In the group of HIV positive patients, 72% were classified as immunodeficient according to their CD4 counts. An association was proven between severely immunodeficient patients and the risk of VKC-like disease (Chi-squared = 4.992, P value = 0.0255).Conclusion:In this cohort, a statistically significant association was found between VKC-like disease in adults and an HIV positive status. This association calls for more research on the subject.

Auditory, video head impulse test and vestibular evoked myogenic potentials findings in adults with human immunodeficiency virus

ObjectivesEven though there is an association between hearing loss and human immunodeficiency virus (HIV), particularly in low- and middle-income countries, further research is needed to investigate the nature of such hearing loss. Likewise, despite documented vestibular alterations in people with HIV, the true occurrence, presentation, and nature of these manifestations are yet to be established. Advances in technology for vestibular testing has allowed for objective site-of-lesion tests such as the video head impulse test (vHIT), cervical vestibular evoked myogenic potentials (cVEMPs) and ocular vestibular evoked myogenic potential (oVEMPs). The current study aimed to compare and describe auditory, vHIT, cVEMPs and oVEMPs findings in adults with and without HIV. MethodsThe current study included an HIV positive group (n = 30) and an HIV negative group (n = 30) who underwent an auditory assessment (tympanometry and pure tone audiometry) and objective vestibular assessments. ResultsThe occurrence of hearing loss was 53.3% in the HIV positive group compared to 33.3% in the HIV negative group. A higher occurrence of vestibular involvement was documented in the HIV positive group (73.3%) compared to 13.3% in the HIV negative group. ConclusionAuditory assessment and objective measures of vestibular end-organ function (vHIT and VEMPs) can be useful to detect sub-clinical alterations. The equipment is mobile and can be performed in any health care setting such as infectious disease clinics for surveillance and monitoring purposes.

Malaria parasite prevalence and Haematological parameters in HIV seropositive patients attending the regional hospital Limbe, Cameroon: a hospital-based cross-sectional study

BackgroundMalaria and the human immunodeficiency virus (HIV) infection constitute public health problems in Cameroon including the South West Region (SWR). This study determined the prevalence of malaria parasites and haematological abnormalities in HIV positive patients in Limbe, Cameroon from April–July 2014.MethodsThe study was cross-sectional and involved 411 participants who were administered structured questionnaires to record socio-demographic and clinical data. Three hundred and nine (309) HIV positive patients and one hundred and two (102) HIV negative individuals were examined clinically and venous blood collected for malaria parasite detection, HIV infection diagnosis and full blood count analysis.ResultsOverall malaria parasite prevalence was 14.1% (58/411). This prevalence was significantly higher (P < 0.001) in the HIV negative participants (33.3%, 34/102) compared to the HIV positive patients (7.8%, 24/309). Amongst HIV positive participants, malaria parasite prevalence was significantly higher in female patients (P = 0.003), febrile patients (P < 0.001), anaemic patients (P = 0.015) and in patients who were not on antiretroviral treatment (ART) (P = 0.03) when compared with their respective counterparts. Among the HIV negative group, though not significant, malaria parasite prevalence was higher in females, febrile and anaemic patients when compared with their respective counterparts. Overall anaemia prevalence was 52.1% (214/309) and was significantly higher (P = 0.004) in HIV positive patients (56%, 173) than in HIV negative participants (40.2%, 41). Malaria/HIV co-infected patients had a significantly lower mean value of Hb (P = 0.002), RBC (P = 0.002) and Hct (P = 0.001) when compared with HIV-infected patients.ConclusionHIV negative participants had a higher prevalence of malaria parasites than their HIV positive counterparts. Anaemia prevalence was higher in HIV positive patients than in HIV negative participants. Malaria/HIV co-infected patients presented with more red blood cell abnormalities than HIV-infected patients.

Evaluation of Salivary Vitamin C and Catalase in HIV Positive and Healthy HIV Negative Control Group.

Saliva is a complex oral biologic fluid secreted by major and minor salivary glands. Saliva has immunological, enzymatic and antioxidant defense mechanisms. Infection with human immunodeficiency virus (HIV) is a life-threatening disease. The aim of this study was to evaluate salivary vitamin C and catalase levels in HIV-positive patients in comparison to a healthy control group. Forty-nine HIV-infected individuals and 49 healthy subjects were selected. Five mL of unstimulated saliva was collected in 5 minutes using a sterilized Falcon tube with Navazesh method. Catalase and vitamin C levels were assessed by spectrophotometric assay. Data were analyzed with STATA 12. Salivary catalase levels were 7.99±2.40 and 8.37±1.81 in the case and control groups, respectively. Catalase level was lower in the case group but the difference was not statistically significant (P=0.380). Salivary vitamin C levels in the case and control groups were 3.76±1.92 and 4.87±2.20, respectively (P=0.009). HIV can alter salivary antioxidant capacity as well as vitamin C and catalase levels. Saliva may reflect serum antioxidative changes in these patients. Therefore, further research is necessary on salivary and serum oxidants and the antioxidant changes.

Genital herpes and HIV status: a clinical study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Genital herpes (GH) is a sexually transmitted infection (STI) increases risk of human immunodeficiency virus (HIV) infection. Some risk factors like age, sex, previous genital ulcerative disease (GUD), number of sex partners and clinical presentations like number and size of erosions, number of episodes, inter-episode duration, healing period with acyclovir &amp;amp; co-STDs are studied with reference to HIV status&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a longitudinal, observational study comparing 25 patients each in HIV positive and negative groups of GH between 15-60 years of age in both genders. Chi square test (or Fisher’s exact test) for nominal data and ‘t’ test for continuous data was used in case of association. Mann Whitney U test was used for comparison of mean ranks and median.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Adolescents were 18%. HIV positivity was significantly associated with age group above 45 years, multiple sex partners, average number of episodes &amp;amp; the duration between them and number of erosions (p &amp;lt;0.05). Healing period with acyclovir in HIV positive patients was significantly longer than in HIV negative patients. Secondary syphilis a co-STD had significant association with HIV positivity. Though previous GUD alone was not associated with HIV positivity significantly; however GUD in patients with multiple sexual partners showed significant association with HIV&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; High proportion of adolescents amongst GH patients is notable. Adolescents &amp;amp; older patients above 45 years should not be neglected in STD &amp;amp; HIV awareness. Risk factors must be interviewed with patients. Clinical parameters &amp;amp; risk factors, differs with HIV status&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Analysis of the surgical treatment of fracture in HIV positive patients: A clinical study.

Objective:To evaluate the incidence of postoperative infection and fracture nonunion as well as the risk factors for postoperative infection in human immunodeficiency virus (HIV) positive patients.Methods:From May 2013 to March 2016, the HIV positive fracture patients treated surgically in orthopaedics department of our hospital were analyzed retrospectively, and fifty HIV negative fracture patients during the same period were selected as control. The clinical data of included patients were reviewed. The incidence of postoperative infection and fracture nonunion were compared between the two groups, and the risk factors for postoperative infection in HIV positive patients were evaluated.Results:The incidence of poor wound healing and incision infection in HIV positive group was higher than that in HIV negative group, but there were no significant differences between the two groups (p>0.05). Multivariable regression analysis demonstrated that HIV clinical category (p<0.05), CD4+T-lymphocyte category (p<0.01) and open fracture (p<0.05) were independent risk factors for postoperative wound infections, but age, gender, operation time, incision type, emergency operation, albumin and lymphocyte count were not (p>0.05). There was no significant difference in the rate of nonunion between the two groups (p>0.05).Conclusion:The incision can be healed, and fracture can be united normally in most of HIV positive patients with fracture, and postoperative wound infections were significantly associated with HIV clinical category, CD4+T-lymphocyte category and open fracture.

Prevalence of Hepatitis B Virus and HIV Co-infection in Korea

Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) have a common route like sexually transmitted infections (STIs), vertical transmission and blood transfusion, etc. Therefore, it was necessary to be an attempt to confirm the relationship of HBV and HIV in Korea. We investigated the prevalence of Hepatitis B surface antigen (HBsAg) and Hepatitis B core antibody (anti-HBc) in HIV positive groups (n=430) and HIV negative groups (n=434) from January 2014 to October 2015. When comparing the prevalence of anti-HBc between the two groups, HIV positive group (36.0%) showed a higher prevalence than HIV negative group (24.7%), the result was statistically significant (p ＜ 0.05). However, there was a little difference on HBsAg and not significant. Therefore, by showing a clear difference in anti-HBc between the two groups of HIV in Korea, it was confirmed to be associated with co-infections between Hepatitis B and HIV.

Patterns of Lymph Node Pathology; Fine Needle Aspiration Biopsy as an Evaluation Tool for Lymphadenopathy: A Retrospective Descriptive Study Conducted at the Largest Hospital in Africa.

BackgroundLymphadenopathy is a common clinical presentation of disease in South Africa (SA), particularly in the era of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) co-infection.MethodsData from 560 lymph node biopsy reports of specimens from patients older than 12 years at Chris Hani Baragwanath Academic Hospital (CHBAH) between 1 January 2010 and 31 December 2012 was extracted from the National Health Laboratory Service (NHLS), division of Anatomical Pathology. Cytology reports of lymph node fine needle aspirates (FNAs) performed prior to lymph node biopsy in 203 patients were also extracted from the NHLS. Consent was not obtained from participants for their records to be used as patient information was anonymized and de-identified prior to analysis.ResultsThe majority of patients were female (55%) and of the African/black racial group (90%). The median age of patients was 40 years (range12–94). The most common indication for biopsy was an uncertain diagnosis (more than two differential diagnoses entertained), followed by a suspicion for lymphoma, carcinoma and TB. Overall, malignancy constituted the largest biopsy pathology group (39%), with 36% of this group being carcinoma and 27% non-Hodgkin lymphoma. 22% of the total sampled nodes displayed necrotizing granulomatous inflammation (including histopathology and cytology demonstrating definite, and suspicious for mycobacterial infection), 8% comprised HIV reactive nodes; in the remainder no specific pathology was identified (nonspecific reactive lymphoid hyperplasia). Kaposi sarcoma (KS) accounted for 2.5% of lymph node pathology in this sample. Concomitant lymph node pathology was diagnosed in four cases of nodal KS (29% of the subset). The co-existing pathologies were TB and Castleman disease. HIV positive patients constituted 49% of this study sample and the majority (64%) of this subset had CD4 counts less than 350 cells/ul. 27% were HIV negative and in the remaining nodes, the HIV status of patients was unknown. The most common lymph node pathologies in HIV positive patients were Mycobacterial infection (31%), HIV reactive nodes (15%), non-Hodgkin lymphoma (15%) and nonspecific reactive lymphoid hyperplasia (15%). Only 8.7% were of Hodgkin lymphoma. In contrast, the most common lymph node pathologies in HIV negative patients were nonspecific reactive lymphoid hyperplasia (45%), carcinoma (25%) and Mycobacterial infection (11%). In this group, non-Hodgkin lymphoma and Hodgkin lymphoma constituted 9% and 8%, respectively. There were more cases of high-grade non-Hodgkin lymphoma in the HIV positive group compared to the HIV negative group. FNA and lymph node biopsy had statistically significant good agreement with regard to Hodgkin lymphoma (K 0.774, SE 0.07, 95% CI 0.606-0.882, p=0.001), non-Hodgkin lymphoma (K 0.640, SE 0.07, 95% CI 0.472-0.807, p=0.001), carcinoma (K 0.723, SE 0.069, 95% CI 0.528-0.918, p=0.001), and mycobacterial infection (K 0.726, SE 0.07, 95% CI 0.618-0.833, p=0.001).ConclusionsThe most common lymph node pathologies in CHBAH are malignancies, nonspecific reactive lymphoid hyperplasia, necrotizing granulomatous inflammation and HIV reactive nodes. The distribution of disease differs in HIV positive patients. Overall, adequate FNA samples of lymph nodes have been found to have good correlation with lymph node biopsy findings in our setting.

Hepatitis B virus seroprevalence and its correlation with CD4 cells and liver enzymes among human immunodeficiency virus positive individuals at a tertiary care hospital in North-West India.

Background:Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are global health concerns. Due to shared routes of transmission, co-infection is common. Their co-existence can cause severe liver complications and immunological impairment in infected individuals.Aim:To find the prevalence of HBV co-infection in HIV patients and to assess the pattern of liver enzymes and CD4 T-cell counts in HIV monoinfected and HIV/HBV co-infected patients.Materials and Methods:A total of 342 consecutive confirmed HIV positive treatment naïve patients were tested for hepatitis B surface antigen (HBsAg). Clinical staging was done according to Centers for Disease Control and Prevention classification guidelines. Liver function tests were performed by an autoanalyser. CD4 T-cells were estimated by FACS Calibur.Results:Hepatitis B virus co-infection was detected in 8.7% of HIV positive patients as compared to 1.42% in the HIV negative control group (P < 0.05). Majority of the HIV monoinfected and co-infected patients were below 38 years. HBsAg positivity was higher in males (9.4%) and the route of transmission was heterosexual. Categorical data revealed significantly higher proportion of alanine aminotransferase and aspartate aminotransferase (AST) in the co-infected patients compared to the monoinfected patients (P < 0.05). The HIV/HBV co-infected patients had significantly lower CD4 T-cell counts (P = 0.03) and significantly higher AST, alkaline phosphatase and serum bilirubin values (P = 0.023, P = 0.029, P = 0.009 respectively) than the monoinfected group. Males had 1.33 times higher risk than females for co-infection (odds ratio = 1.33; 95% confidence interval 0.57–3.10).Conclusion:The prevalence of co-infection was high. Raised levels of liver enzymes and lowered CD4 counts were seen in co-infected patients. These findings underscore the importance of HBV screening of all HIV positive individuals before initiating antiretroviral treatment.

SÍFILIS NUMA CONSULTA DE INFECÇÕES SEXUALMENTE TRANSMISSÍVEIS – ANÁLISE DE 880 DOENTES

Introdução: Estudo epidemiológico de doentes com sífilis observados numa Consulta de Infecções Sexualmente Transmissíveis (IST) e caracterização de doentes com sífilis co-infectados por vírus da imunodeficiência humana (VIH) e de sífilis em homens que têm sexo com homens (HSH). Métodos: Análise retrospectiva de dados sócio-demográficos, clínicos e laboratoriais de doentes com sífilis entre os anos de 1998 e 2009. Resultados: A análise incluiu 880 doentes, dos quais 69,9% eram do sexo masculino. A idade variou entre 15 e 91 anos (41,4±13,3 anos). Em 56,6% dos doentes diagnosticou-se sífilis recente e em 13,0% registou-se associação com outra IST. Identificaram-se 87(9,9%) doentes com infecção VIH, 33(37,9%) dos quais de novo. No grupo de doentes VIH positivo, observou-se maior prevalência HSH (32,6%vs3,8%) e de IST concomitantes (36,8%vs10,6%) do que no grupo de doentes VIH negativo (p&lt;0,05). Nos doentes com infecção VIH conhecida, constatou-se significativamente mais doentes com sífilis recente (70,4%) e com IST concomitante (31,5%) (p&lt;0,05). Comparando os HSH (n=56) e os homens heterossexuais (n=545) registou-se nos primeiros maior prevalência de co-infecção VIH (50,0%vs9,9%), de sífilis recente (78,6%vs57,4%) e de outra IST conco- mitante (26,8%vs15,8%) (p&lt;0,05). Discussão: Na nossa casuística foi observado maior número de IST de novo no grupo VIH, inclusivamente naqueles em que o diagnóstico já era conhecido. Nos HSH encontrámos elevada prevalência de co-infecção VIH, sífilis recente e diagnóstico simultâneo de outras IST. Este estudo enfatiza a necessidade de campanhas de sensibilização dirigidas a grupos específicos, como os doentes com infecção VIH e os HSH.PALAVRAS-CHAVE – Comportamento Sexual; Doenças Sexualmente Transmissíveis; Homosexualidade Masculina; Infecção por HIV; Sífilis.

Magnetic resonance imaging findings in spinal tuberculosis: Comparison of HIV positive and negative patients

Background:There is an increasing incidence of Human immunodeficiency virus (HIV) and tuberculosis (TB) co-infection. This has led to an increasing number of atypical features on magnetic resonance imaging (MRI). We postulated that the type 4 hypersensitivity response causing granulomatous inflammation may be disrupted by the HIV resulting in less vertebral body destruction. This study compares the MRI features of spinal tuberculosis in HIV positive and negative patients.Materials and Methods:Fifty patients with confirmed spinal tuberculosis, HIV status and available MRI scans at a single institution from 2003-2009 were identified. HIV status was positive in 20 and negative in 30. Females were predominant (34:16). The HIV positive group was younger at 32.4 versus 46 years (P=0.008). Blood parameters (WCC, ESR, Hb, Lymphocyte count) were not significantly different between the HIV groups. MRI scans were reviewed by a radiologist who was blinded to the HIV status. Site, extent of disease, body collapse, abscess location and volume, kyphotic deformity and cord signal were reported.Results:There was no difference between the number of vertebral bodies affection with TB involvement, presence of cord signal or incidence of non-contiguous lesions. The HIV negative group had significantly more total vertebral collapse (P=0.036) and greater kyphosis (P=0.002). The HIV positive group had a trend to larger anterior epidural pus collection (P=0.2).Conclusion:HIV negative patients demonstrate greater tuberculous destruction in terms of total percentage body collapse and resultant kyphosis. There is no difference in the incidence of cord signal or presence of non-contiguous lesions. HIV positive patients show a trend to a greater epidural abscess volume. This difference may be explained by the reduced autoimmune response of the type 4 hypersensitivity reaction caused by the HIV infection.

Co-infection of HIV and intestinal parasites in rural area of China.

BackgroundIntestinal parasite infections (IPIs) are among the most significant causes of illness and disease of socially and economically disadvantaged populations in developing countries, including rural areas of the People's Republic of China. With the spread of the human immunodeficiency virus (HIV) among rural Chinese populations, there is ample scope for co-infections and there have been increasing fears about their effects. However, hardly any relevant epidemiological studies have been carried out in the country. The aim of the present survey was to assess the IPI infection status among a representative sample of HIV-positive Chinese in rural Anhui province, and compare the findings with those from a cohort of non-infected individuals.MethodsA case control study was carried out in a rural village of Fuyang, Anhui province, China. Stool samples of all participants were examined for the presence of intestinal parasites. Blood examination was performed for the HIV infection detection and anemia test. A questionnaire was administered to all study participants.ResultsA total of 302 HIV positive and 303 HIV negative individuals provided one stool sample for examination. The overall IPI prevalence of intestinal helminth infections among HIV positives was 4.3% (13/302) while it was 5.6% (17/303) among HIV negatives, a non-significant difference. The prevalence of protozoa infections among HIV positives was 23.2% while the rate was 25.8% among HIV negatives. The species-specific prevalences among HIV positives were as follows: 3.6% for hookworm, 0.7% for Trichuris trichiura, zero for Ascaris lumbricoides, 0.3% for Clonorchis sinensis, 1.3% for Giardia intestinalis, 16.2% for Blastocystis hominis, 1.7% for Entamoeba spp. and 8.3% for Cryptosporidium spp.. Cryptosporidium spp. infections were significantly more prevalent among HIV positives (8.3%) compared to the HIV negative group (3.0%; P < 0.05). Among people infected with HIV, Cryptosporidium spp. was significantly more prevalent among males (12.6%) than females (4.4%; P < 0.05). According to multivariate logistic regression, the factors significantly associated with parasite infections of the people who were HIV positive included sex (male: OR = 6.70, 95% CI: 2.030, 22.114), younger age (less than 42 years old: OR = 4.148, 95% CI: 1.348, 12.761), and poor personal hygiene habits (OR = 0.324, 95% CI: 0.105, 0.994).ConclusionsHIV positive individuals are more susceptible to co-infections with Cryptosporidium spp. than HIV negative people, particularly younger males with poor personal hygiene habits, indicating a need for targeted hygiene promotion, IPI surveillance and treatment.

Prevalence and risk factors of Hepatitis C among individuals presenting to HIV testing centers, Hawassa city, Southern Ethiopia

BackgroundHepatitis C virus (HCV), either alone or in combination with Human Immunodeficiency virus (HIV), constitutes a major public health concern. This study was conducted to describe the prevalence and risk factors for HCV infection in people with and without HIV infection.MethodsBlood samples and data on socio-demographic and risk factors for HCV infection were collected from consecutive 400 HIV- positive and 400 HIV- negative individuals attending HIV testing centers in Hawassa city, from October to December, 2008. All sera were tested for antibody to HCV infection (anti-HCV) using enzyme linked immunosorbent assay (ELISA). Sera positive for anti-HCV were further tested for viral ribonucleic acid (RNA) levels using real-time polymerase chain reaction.ResultsThe rate of anti-HCV positivity was 10.5% in the HIV- infected individuals compared with 6% in the HIV negative group (p = 0.002). HCV-RNA was detected in 9.1% of anti-HCV positive samples and rates were comparable between HIV- infected and HIV- non-infected individuals. There was no significant difference in odds of HCV infection in participants with and without HCV risk factors in either HIV sero-group.ConclusionHIV infected individuals had significantly higher rate of anti-HCV although most of them showed no evidence of viraemia. Hence, while priority should be given for HIV infected patients, testing those with anti-HCV for HCV-RNA remains important.

In Patients with Retroviral Infection Thrombotic Thrombocytopenic Purpura Is Highly Responsive to Infusions of Plasma.

In patients infected with human immunodeficiency virus (HIV), thrombotic thrombocytopenic purpura (TTP) appears to follow a heterogenous clinical pattern. There are few studies looking prospectively at their outcome. We compared the clinical characteristics and response to therapy in consecutive patients with TTP and tried to define the differences between the HIV positive and negative groups. Patients with TTP were evaluated clinically and with standard tests. Patients were then treated with infusions of cryoprecipitate poor fresh frozen plasma (FFP)(30 mL/kg/day) until normalization of the platelet count. Patients were given daily furosemide according to clinical needs. In responding patients FFP was tapered off by 200 mL every 3rd day. In addition, all received prednisone 1mg/kg until FFP therapy was discontinued. Patients who developed fluid overload, and who failed to respond within 48 Hs or deteriorated at any time were referred for apheresis of 1½ plasma volume until response. Similar tapering off with plasma infusions would then proceed in responsive individuals. Of 45 patients with TTP 21 were HIV+. This disorder was dominant among black females (20/21). HIV+ patients had significantly lower presentation Hb (5.8 [range 3.9–9.8] g/dL; p= 0.03), platelet count (13 [range 7–49] x 109/L; p= 0.05) and a CD4 count of 0.096 x 109/L, indicating advanced disease. However, except for one, all HIV+ subjects responded rapidly to FFP infusions. The platelet count and LDH levels normalised significantly faster than HIV (−) group and in no case was apheresis required. 1 patient died of fulminant septicemia before response was documented. 10 HIV (−) patients with idiopathic TTP required apheresis due to oliguria (n= 4) or disease progression (N= 6; 25%). Of these, 4 died of TTP despite apheresis. The remainder (n= 6) as well as those not requiring apheresis, improved. Response in the 2 groups was at a median of 41(HIV+) and 96 (HIV−) units (U= 220 mL. plasma) of FFP (p= 0.004) respectively. Three patients relapsed and two responded to a further course of FFP and splenectomy. 5 individuals with AIDS died of opportunistic infections. Overall 84% responded to this protocol, which was particularly favourable in patients with HIV infection (95% response). Multiple regression analysis showed that the favorable factors for response were HIV+ status (p= 0.002), younger age (p= 0.0001) and no need for apheresis (p= 0.00). Factors associated with improved survival were younger age (p= 0.001), rapid platelet (p= 0.001) and Hb (p= 0.0009) recovery, and lower number of FFP units to normalize LDH (p= 0.006). We conclude that while compared to classic (HIV(−)) TTP, patients who are HIV+ seem to be more commonly seen among African Black patients with advanced infection. In these patients, response to plasma infusion therapy seems significantly better and faster. This observation is important particularly when apheresis is not available as happens in remote rural areas in developing countries. In these patients, once the diagnosis is established, adequate volume of FFP should be infused without delay.

Dissociation of serum and liver hepatitis C virus RNA levels in patients coinfected with human immunodeficiency virus and treated with antiretroviral drugs.

We examined hepatitis C virus (HCV) RNA levels in serum, peripheral blood mononuclear cells (PBMC), and the liver for 135 patients with chronic HCV infections, 44 of whom were human immunodeficiency virus (HIV) positive and treated with highly active antiretroviral therapy (group A), 66 of whom were HIV negative (group B), with abnormal serum alanine aminotransferase (ALT) values, and 25 of whom were HIV negative, with ALT values of </=1.5 times the normal value (group C). Patients had not been treated with interferon, with or without ribavirin, at the time of the study. A statistically significant correlation between HCV RNA levels in the liver and serum was reproducibly documented, whereas this was inconsistent for serum and PBMC. A comparative evaluation of HCV RNA levels in the liver and PBMC showed significantly lower values for group A than for groups B and C (P < 0.01 and P < 0.0001, respectively). In contrast, HCV RNA levels in serum were significantly higher for group A than for group B (P < 0.001). A dissociation between HCV RNA levels in serum and the liver was found for patients with HIV-HCV coinfections. Although the relative contribution of extrahepatic reservoirs, including lymphoid cells, to HCV RNA levels in serum is unclear, it may be speculated that a low intrahepatic HCV burden is caused by restored immunocompetence after successful antiretroviral therapy in coinfected patients.

Association between Exercise and HIV Disease Progression in a Cohort of Homosexual Men

PURPOSE: To study the relationship between exercise and human immunodeficiency virus (HIV) disease progression. METHODS: 415 individuals (156 HIV positive, 259 HIV negative), from a cohort study of 851 homosexual men from New York City, 1985–1991. By 1991, 68 of the 156 persons developed Acquired Immune Deficiency Syndrome (AIDS) and 49 died with AIDS. Exercise was defined as self-report of exercising 3–4 times/week or daily at entry; less was considered nonexercise. CD4 lymphocyte decline was constructed for each subject by modeling log CD4 count against time in days. The association between exercise and progression to AIDS and death with AIDS, adjusting for baseline CD4 count, was determined using Cox model. Linear regression was used to model CD4 decline with exercise for HIV positive and HIV negative groups separately, adjusting for initial CD4 count. RESULTS: Having exercised was associated with slower progression to AIDS at 1 year ( HR = 0.68, 90% confidence interval CI : 0.4–1.17 ); hazard ratios (HR) at 2, 3, and 4 years were 0.96, 1.18, and 1.36, respectively. Having exercised was also associated with slower progression to death with AIDS at 1 year (HR = 0.37, 90% CI: 0.14–0.94) with hazard ratios at 2, 3, and 4 years of 0.68, 0.98, and 1.27, respectively, suggesting a protective effect close to the time exercise was assessed, but an increased risk after 2 years. Exercising 3–4 times/week had a more protective effect than daily exercise. Exercisers in the HIV positive group showed an increase in CD4 count during a year by a factor of 1.07. CONCLUSION: Moderate physical activity may slow HIV disease progression.