Human Immunodeficiency Virus Negatives Research Articles

Hepatitis B and C virus infections and associated factors among HIV-positive and HIV-negative tuberculosis patients in public health facilities, Northeast Ethiopia: A comparative cross-sectional study.

Viral hepatitis, particularly hepatitis B virus and hepatitis C virus, is the leading cause of global liver-related morbidity and mortality. Concomitant infections of hepatitis B virus, hepatitis C virus, and tuberculosis are risks of hepatotoxicity and death due to antituberculosis therapy. Hepatitis and human immunodeficiency virus coinfection poses challenges in treating hepatotoxic patients and leads to mortality during antituberculosis treatment. Thus, this study aimed to determine the prevalence of hepatitis B virus and hepatitis C virus infections, and associated factors among human immunodeficiency virus-positive and human immunodeficiency virus-negative tuberculosis patients attending public health facilities, Northeast Ethiopia. A comparative cross-sectional study was conducted among 229 tuberculosis patients from January 1 to April 30, 2021 in public health facilities' tuberculosis treatment centers. Study participants were selected using a consecutive sampling technique. Data on sociodemographic and other risk factors were collected using an interviewer-based pretested questionnaire by trained data collectors. Anti-hepatitis C virus and hepatitis B surface antigen were determined in serum using enzyme-linked immunosorbent assay. Data were entered and analyzed using SPSS version 22. Logistic regression analysis was computed, and then variables with a p value <0.05 were considered as statistically significant. The overall hepatitis virus infection among human immunodeficiency virus-positive and human immunodeficiency virus-negative tuberculosis patients was 14.03% and 8.14%, respectively. The prevalence of hepatitis B virus infection in human immunodeficiency virus positives and human immunodeficiency virus negatives was 10.5% and 6.4% and hepatitis C virus infection in human immunodeficiency virus positives and human immunodeficiency virus negatives was 3.5% and 1.75%, respectively. Hepatitis B virus and hepatitis C virus coinfections were not observed. Older age, history of problematic alcohol use, history of blood transfusion, ear-noise piercing, and history of multiple heterosexual partners were predictors for the hepatitis virus infection. Hepatitis virus infection increases morbidity and mortality of tuberculosis patients. Therefore, screening tuberculosis patients for hepatitis virus infection is necessary to reduce the risk of antituberculosis complications.

Seroprevalence of Syphilis, Human Immunodeficiency Virus and its Co-infection in Patients Attending an ICTC at a Tertiary Care Hospital in Villupuram, Tamil Nadu, India

Introduction: Human Immunodeficiency Virus (HIV) and syphilis co-infection is common and affects similar age groups. The presence of syphilis infection increases the chances of transmission of HIV. Syphilis has a negative impact on HIV infection, resulting in increasing viral loads and decreasing Cluster of Differentiation 4 (CD4) cell counts during syphilis infection. Aim: To determine the seroprevalence of syphilis, quantify HIV-Syphilis co-infection in patients attending an Integrated Counseling and Testing Centre (ICTC) centre. Materials and Methods: This cross-sectional study was conducted at the Department of Microbiology, Government Villupuram Medical College, Tamil Nadu, India, for a period of four months from March 2021 to June 2021. All consecutive adult patients attending ICTC during the study period for voluntary testing or referred from antenatal clinic or Sexually Transmitted Disease (STD) clinic were included. Patients who were on treatment or follow-up of syphilis were excluded. Pretest counselling session was given and consent was taken for HIV testing. The HIV antibody tests were performed and interpreted according to the National AIDS Control Programme (NACO) guidelines. Rapid Plasma Reagin test (RPR) screening was done. Positive cases were subjected to Treponema pallidum Haemagglutination Assay (TPHA) and Syphilis Rapid Immunochromatographic Test (RICT). The results were analysed with the data systematically entered in Microsoft Excel format and p-value was calculated by Fisher’s- exact test using epi infoTM software. Results: Among the 400 patients attending the ICTC who were included in the study, six patients had a reactive HIV test. The overall HIV positivity was 1.5% (6/400). The RPR test was positive in 7/400 patients (1.75%). Among the seven patients with RPR positivity, five patients were positive by TPHA and Syphilis RICT. Biological False Positivity (BFP) rate in RPR against TPHA was 28%. Thus the frequency of syphilis among the study population by the confirmatory test TPHA was 1.25%. Among the five confirmed cases of syphilis, four patients were males (80%) and one patient was female gender (20%). Four of the five patients were in the 28-37 year old age group (80%) and one patient was in the 38-47 year age group (20%). The frequency of syphilis was 16.67% among HIV positives (17%) and 1.02% among HIV negatives biological false positivity by RPR was observed in 29% of the cases. Conclusion: HIV and Syphilis co-infection is common and Specific Treponemal tests could contribute to reducing errors due to false positivity by non specific tests like RPR which can be used as a screening test in microbiology laboratories.

Performance Characteristics of Urine HIV Screening Methods against Blood-Based Methods for Surgeons Guide

Testing for Human Immunodeficiency Virus (HIV), widely distributed in sub-Saharan Africa since it is mainly invasive but, could be non-invasive and quick also, reducing waiting time especially when required for presurgical procedures. This study determined the HIV status of patients using Urine screening test method and to compare its performance to blood-based testing methods. The routine pre and post-test counselling for HIV screening were done for all provider-initiated HIV testing using blood-based screening methods. Due to the cost and unavailability of enough urine testing kits, only patients who tested positive for HIV with blood-based methods and were scheduled for surgery or a surgical procedure were enrolled in the study. Informed consent was obtained. Paired urine and blood samples were collected at the same visit into clean universal bottles and analyzed immediately. A colloidal gold enhanced rapid immuno-chromatographic assay (Alliance Biomedical) kit for the rapid qualitative detection of antibodies to Human Immunodeficiency Virus (HIV) I and II in urine were used in comparison to the standard HIV testing of ante-cubital venous blood collected in EDTA vacutainer and analyzed using Determine (T) HIV 1 and 2 in vitro qualitative immunoassay strip, UNI GOLD rapid test kit and the Chembio HIV 1/2 STAT PAK assay strip. A total of 7568 patients were tested for routine provider-initiated HIV testing, 521 tested HIV positive. There were 105 (20.15%) males and 416 (79.85%) females, age ranged from 15 years to >80 years. Most of the surgeries performed were Caesarian section 93 (37%), Hernia 55 (22%), Lumps 48 (19%), Acute appendicitis 33 (13%), Uterine fibroids 10 (4%), Ruptured ectopic pregnancy 2 (1%) and others (Intestinal obstruction, Postoperative adhesions, Ingrown toe nails, Breast abscess, Hemorrhoids, Anal fissures etc.) 10 (4%). DETERMINE RAPID HIV TEST METHOD USING BLOOD: A total of 521 HIV positive samples were tested, 502 (96.35%) tested HIV positive and 19 (3.65%) tested HIV negative. These 19 HIV negatives were re-tested with Stak Pak: 19 (100%) tested HIV positive. UNI GOLD HIV TEST METHOD USING BLOOD: A total of 521 HIV positive samples were tested, 521 (100%) tested HIV positive. URINE TESTING METHOD: A total of 251 (48.18%) of the 521 HIV positive patients were scheduled to undergo a surgical procedure. These were re-tested using the Urine testing method, 235 (93.63%) tested HIV positive while 16 (6.37%) tested negative. The blood sample of the 16 who tested negative using the Urine testing method was subjected to confirmatory test using Stat Pak and all 16 (100%) tested HIV positive. The specificity for Unigold and Determine blood testing was 100%. All three tests had a Positive Predictive Value (PPV) of 100% while the Negative Predictive Values (NPV) were 100% and 99.73% for Unigold and Determine respectively. The use of Urine HIV testing method compared well to the blood HIV testing methods and could be a better non-invasive sample method for screening of HIV/AIDS in the population especially among surgeons’ pre-surgical procedures.

Light-emitting diode fluorescent microscopy and Xpert MTB/RIF\xae assay for diagnosis of pulmonary tuberculosis among patients attending Ambo hospital, west-central Ethiopia

BackgroundThe relatively simple and cheaper light-emitting diode fluorescent microscopy (LED-FM) was recommended by the World Health Organization (WHO) to replace the conventional tuberculosis (TB) microscopy in both high- and low-volume laboratories. More recently the WHO also endorsed one more technique, Xpert MTB/RIF® assay (Xpert), for improved TB diagnosis particularly among human immunodeficiency virus (HIV)-infected cases. However, the relative performance of both of these tools differs from setting to setting in reference to the conventional TB diagnostics. This study thus aimed to evaluate these tools for TB detection in individuals visiting Ambo Hospital, west-central Ethiopia.MethodsCross-sectional early-morning sputum samples were collected from presumptive TB patients between January and August 2015. Socio-demographic data were captured using a structured questionnaire. Clinical information was gathered from patients’ medical records. The sputum samples were diagnosed using LED-FM, Xpert, concentrated Ziehl-Neelsen (cZN) staining and Lowenstein-Jensen (LJ) culture as the gold standard. Drug sensitivity test (DST) was also conducted.ResultsOut of 362 sputum samples collected and processed, 36(9.9%) were positive by LED-FM, 42(11.6%) by cZN and 50(13.8%) by Xpert. But, only 340 samples could be declared culture positive or negative for mycobacteria. Of these 340, eight were non-tubercle mycobacteria (NTM). Out of the remaining 332 samples, 45(13.6%) had culture-confirmed TB with 11(24.4%) being HIV co-infected. LED-FM, Xpert and culture detected 54.5% (6/11), 90.9% (10/11) and 100% (11/11) mycobacteria in HIV-positive individuals and 81.3% (26/32), 73.7% (28/38), 78.8% (26/33) and 73.2% (30/41), in HIV negatives respectively. Two samples were rifampicin resistant by both Xpert and DST. The overall sensitivity, specificity, positive and negative predictive values of LED-FM and Xpert were 77.8, 100, 100 and 96; and 93.3, 98, 97.5 and 98.9% respectively.ConclusionThe data demonstrated the high diagnostic yield of Xpert. LED-FM sensitivity is higher compared to results quoted by recent systematic reviews although it appears to be lower than what was cited in the WHO policy statement (83.6%) during the recommendation of the technology. The high specificity of LED-FM in the study area is encouraging and is expected to boost its reliability and uptake.

Economic support intervention improves tuberculosis treatment outcomes in rural Nigeria.

A secondary care hospital in rural Nigeria. To investigate the feasibility of providing financial incentives to tuberculosis (TB) patients under routine conditions, and to determine their impact on TB treatment outcomes in a low-resource setting. A prospective, non-randomised intervention study. A total of 294 TB patients (respectively 173 and 121 in the control and intervention periods of 3 months' duration each) were registered in the study. The patients did not differ in terms of their demographic or clinical characteristics (P not significant). The treatment success rate was 104/121 (86.0%) during the intervention, and 123/173 (71.1%) during the control period (P = 0.003). The proportion of patients who were lost to follow-up significantly decreased during the intervention period (20.2% vs. 5.0%, P <0.001). There were no differences in deaths (P = 0.8) or treatment failure rates (P = 0.5) in the intervention and control periods. There was also no difference in the rate of sputum smear conversion after the intensive phase of treatment (88.1% vs. 91.5%, P = 0.5). Independent determinants of treatment success were female sex (adjusted odds ratio [aOR] 1.9), human immunodeficiency virus negativity (aOR 2.5) and receiving financial incentives (aOR 2.3). Financial incentives proved to be effective in improving treatment success and reducing loss to follow-up among poor TB patients in Nigeria.

Tuberculosis in a Portuguese Cohort

Background: Tuberculosis (TB) is a multisystemic disease and a leading cause of infectious disease-related mortality worldwide. Objectives: This study aims to characterize patients with TB in a portuguese cohort. Methods: Retrospective analysis of files pertaining inpatients with TB admitted between 1/2005 - 12/2014. Data were analysed using χ2 or Fisher exact test (p<0.005 = statistically significant) and odds ratio was calculated. Results: 222 cases were found: 128 patients had pulmonary involvement (PTB) and 100 extrapulmonary disease (ETB) (6 had overlapping disease), with men being mostly affected. The most common locations of ETB were lymphatic (27.0%), meningeal and osteoarticular (both 19.0%). The majority exhibited risk factors (64.0%, p<0.005). PTB was associated with smoking (p=0.000, OR=5.05) and contact with TB-infected person (p=0.002, OR=7.53). Human immunodeficiency virus (HIV) infection (p=0.000, OR=5.16) and age > 65 (p=0.005, OR=3.34) were associated with ETB. 48 patients were HIV-infected, with median CD4 count of 74.5 cells/μL (13-136), most cases occurring in the setting of new HIV diagnosis. HIV infection was statistically associated with disseminated (OR=12.64), pleural (OR=8.50), meningeal (OR=2.96) and lymphatic TB (OR=2.38). HIV negativity was associated with pulmonary (OR=4.08) and osteoarticular disease (OR=5.42). PTB was confirmed mainly by culture or PCR test plus smear (81.3%). ETB diagnosis was more complex. Clinical outcome was favourable (PTB 98.4%; ETB 94.0%). Eight patients died. Conclusions: TB remains an important healthcare issue in Portugal. Contact with TB-infected person and smoking (PTB) and HIV infection and age > 65 (ETB), were significant risk factors. HIV infection was associated with disseminated, pleural, meningeal and lymphatic disease.

Highly successful treatment outcome of multidrug-resistant tuberculosis in the Netherlands, 2000–2009

Resistance to the two key anti-tuberculosis drugs isoniazid and rifampicin is a characteristic of multidrug-resistant tuberculosis (MDR-TB). MDR-TB is a scourge requiring toxic, prolonged treatment and is associated with poor outcomes. The Netherlands is a country with a long-standing, integrated, well-resourced TB service where all patients are offered culture-confirmed diagnosis by a central reference laboratory. To assess the treatment outcomes of MDR-TB patients over a period of 10 years in The Netherlands. Demographic, clinical and microbiological features of all patients with MDR-TB who started treatment in 2000-2009 in the Netherlands were analysed from national registry and patient records. Characteristics of the 113 MDR-TB patients were as follows: male/female ratio 1.57, 96% foreign born, median age 29 years, 96 (85%) pulmonary TB, 56 (50%) smear-positive, 14 (12%) human immunodeficiency virus (HIV) co-infected. Of the 104 (92%) patients who started MDR-TB treatment, 86% had a successful outcome using a median of six active drugs; eight underwent pulmonary surgery. HIV negativity was associated with successful outcome (adjusted OR 2.1, 95%CI 1.1-3.8). High success rates for MDR-TB treatment were achieved with close collaboration of all stakeholders, reaching the targets set for drug-susceptible TB. HIV remained an independent risk factor for unsuccessful treatment outcome.

Diversity within the Immunodominant Epitopes of Envelope gp41 HIV-1 in Kenya and Its Effects on Performance of the HIV-1 Antibody-Based Detection Kits

Background: Human Immunodeficiency Virus (HIV) is characterized by high rates of genetic variability in vivo that could affect the performance of the HIV-1 Antibody-Based Detection Kits in use in Kenya. Objective: This study aimed at establishing the diversity of Envelope gp41 Epitopes and its effects on performance of the currently used HIV diagnostic kits in Kenya. Methods: Two hundred (200) HIV positives and 200 HIV negatives samples were collected from the Regional Blood Transfusion Centers (RBTCs) in Kenya. Viral RNA was extracted from 96 HIV Positive samples and sequenced on gp41-immunodominant region (IDR).The sequences obtained were analyzed using various applications in the Los Alamos HIV Database. The HIV gp41-IDR consensus sequence generated was used to synthesize gp41 IDR peptide. The Global HIV gp41-IDR Consensus nucleotide sequence was obtained from literature and used also to synthesis corresponding gp41 IDR peptide. The two peptides were used to prepare HIV Testing ELISA kits. The400 plasma samples that had been collected from this study from RBTCs were tested using five HIV testing kits approved for use in Kenya. The same samples were tested using the two ELISA system developed. Results: The HIV Consensus gp41-IDR peptide from Kenya displays a similarity of 93.0% against HXB2 sequence and 95.3% against Global HIV Consensus gp41-IDR amino acid sequence. There were 331 (7.8%) substitutions in the Consensus gp41-IDR peptides (Kenya) out of which 151substitutions were due to the substitution in positions A96→N (n = 79) and A101→S (n = 75). Both Consensus gp41-IDR peptides (Kenya) and Consensus gp41-IDR peptides (Global) showed common substitutions rate of 4.2% (n = 151). All the kits that were used showed 100% agreement in results. Conclusion: Although the HIV Consensus gp41-IDR peptides (Kenya) showed marked substitutions in respect to Consensus gp41-IDR peptide (Global) there was no difference in effects on the performance of the HIV-1 Antibody-Based Detection Kits in use in Kenya.

The magnitude and risk factors of intestinal parasitic infection in relation to Human Immunodeficiency Virus infection and immune status, at ALERT Hospital, Addis Ababa, Ethiopia

Human Immunodeficiency Virus (HIV) and intestinal parasitic infections are among the main health problems in developing countries like Ethiopia. Particularly, co-infections of these diseases would worsen the progression of HIV to Acquired Immunodeficiency Syndrome (AIDS). The purpose of this study was to determine the magnitude and risk factors for intestinal parasites in relation to HIV infection and immune status. The study was conducted in (1) HIV positive on antiretroviral therapy (ART) and (2) ART naïve HIV positive patients, and (3) HIV-negative individuals, at All African Leprosy and Tuberculosis (TB) Eradication and Rehabilitation Training Center (ALERT) hospital in Addis Ababa, Ethiopia. Study participants were interviewed using structured questionnaires to obtain socio-demographic characteristics and assess risk factors associated with intestinal parasitic infection. Intestinal parasites were identified from fecal samples by direct wet mount, formol ether concentration, and modified Ziehl–Neelsen staining techniques. The immune status was assessed by measuring whole blood CD4 T-cell count. The overall magnitude of intestinal parasite was 35.08%. This proportion was different among study groups with 39.2% (69/176), 38.83% (40/103) and 27.14% (38/140) in ART naïve HIV positives patients, in HIV negatives, and in HIV positive on ART patients respectively. HIV positive patients on ART had significantly lower magnitude of intestinal parasitic infection compared to HIV negative individuals. Intestinal helminths were significantly lower in HIV positive on ART and ART naïve patients than HIV negatives. Low monthly income, and being married, divorced or widowed were among the socio-demographic characteristics associated with intestinal parasitic infection. No association was observed between the magnitude of intestinal parasites and CD4 T-cell count. However, Cryptosporidium parvum, and Isospora belli were exclusively identified in individuals with CD4 T-cell count of ≤350 cells/mm3. Regular provision of mass preventive chemotherapy and extended health education will curb the burden of intestinal parasitic infection in the community. Emphasis should also be given to laboratory diagnosis and identification of opportunistic intestinal parasites in patients with lower CD4-Tcell count.

Hand, foot, and mouth syndrome in an immunocompetent adult: a case report

BackgroundHand, foot, and mouth syndrome (HFMS) is a common acute illness. It is characterized by mild clinical symptoms including fever, blisters, and sores in the mouth and on the palms and soles following a 3- to 7-day incubation period. This syndrome is rarely seen in adults.Case presentationA 35-year-old male Caucasian patient had a history of multiple episodes of acute pharyngitis, hypertension, hypercholesterolemia, and occasional abdominal pain. He presented with polyarthralgia in the knees and hands and odynophagia, followed by fever, oral mucosal aphthous lesions, and vesicles on the palms and soles. Three weeks after presentation, he was admitted to the emergency room with acute myocarditis. The in-hospital evaluation revealed positive serology for coxsackie A9 (1:160), positive anti-transglutaminase and anti-gliadin antibodies, normal immunoglobulins, and human immunodeficiency virus negativity.ConclusionWe herein describe a case of HFMS that was associated with coxsackie A9 infection complicated by acute myocarditis. Although an association between celiac disease and HFMS has not been described, this patient’s immunologic disruption could have favored the development of infection and ultimately HFMS.

Clinical outcome and predictors of survival in patients with pneumocystis jirovecii pneumonia – results of a tertiary referral centre

Pneumocystis jirovecii pneumonia also known as pneumocystis pneumonia (PCP) is an opportunistic respiratory infection in human immunodeficiency virus (HIV) patients that may also develop in non-HIV immunocompromised persons. The aim of our study was to evaluate mortality predictors of PCP patients in a tertiary referral centre. Fifty-one patients with symptomatic PCP were enrolled in the study. The patients had either HIV infection (n = 21) or other immunosuppressive conditions (n = 30). Baseline characteristics (e.g. age, sex and underlying disease) were retrieved. Kaplan-Meier analysis was employed to calculate survival. Comparisons were made by log-rank test. A multivariate analysis of factors influencing survival was carried out using the Cox regression model. Chi-squared test and Wilcoxon-Mann-Whitney test was applied as appropriate. The median survival time for the HIV group was >120 months compared with 3 months for the non-HIV group (P = 0.009). Three-month survival probability was also significantly greater in the HIV group compared with the non-HIV group (90% vs 41%, P = 0.002). In univariate log-rank test, intensive care unit (ICU) necessity, HIV negativity, age >50 years, haemoglobin <10g/dl, C-reactive protein >5 mg/dL and multiple comorbidities were significant negative predictors of survival. In the Cox regression model, ICU and HIV statuses turned out to be independent prognostic factors of survival. PCP is a serious problem in non-HIV immunocompromised patients in whom survival outcomes are worse than those in HIV patients.

Men having sex with men serosorting with casual partners: who, how much, and what risk factors in Switzerland, 2007-2009

BackgroundSerosorting is practiced by men who have sex with men (MSM) to reduce human immunodeficiency virus (HIV) transmission. This study evaluates the prevalence of serosorting with casual partners, and analyses the characteristics and estimated numbers of serosorters in Switzerland 2007-2009.MethodsData were extracted from cross-sectional surveys conducted in 2007 and 2009 among self-selected MSM recruited online, through gay newspapers, and through gay organizations. Nested models were fitted to ascertain the appropriateness of pooling the datasets. Multiple logistic regression analysis was performed on pooled data to determine the association between serosorting and demographic, lifestyle-related, and health-related factors. Extrapolations were performed by applying proportions of various types of serosorters to Swiss population data collected in 2007.ResultsA significant and stable number of MSM (approximately 39% in 2007 and 2009) intentionally engage in serosorting with casual partners in Switzerland. Variables significantly associated with serosorting were: gay organization membership (aOR = 1.67), frequent internet use for sexual encounters (aOR = 1.71), having had a sexually transmitted infection (STI) at any time in the past 12 months (aOR = 1.70), HIV-positive status (aOR = 0.52), regularly frequenting sex-on-premises venues (aOR = 0.42), and unprotected anal intercourse (UAI) with partners of different or unknown HIV status in the past 12 months (aOR = 0.22). Approximately one-fifth of serosorters declared HIV negativity without being tested in the past 12 months; 15.8% reported not knowing their own HIV status.ConclusionThe particular risk profile of serosorters having UAI with casual partners (multiple partners, STI history, and inadequate testing frequency) requires specific preventive interventions tailored to HIV status.

Plasmablastic lymphoma of the elderly: a clinicopathological comparison with age‐related Epstein–Barr virus‐associated B cell lymphoproliferative disorder

Plasmablastic lymphoma (PBL) is an aggressive lymphoma with a terminally differentiated B cell phenotype; half of patients with this disease have Epstein-Barr virus (EBV) infection. The majority of PBL cases are associated with human immunodeficiency virus (HIV) infection, while the remaining HIV-negative cases were accompanied by other immunodeficiency conditions or immunosenescence in the elderly. To characterize HIV-negative PBL of the elderly (PBL-E), we compared the clinicopathological characteristics of 10 cases of PBL-E and 124 cases with age-related EBV-associated B cell lymphoproliferative disorder (AR-EBVLPD). The 10 PBL-E (eight men, two women; median age: 68 years) were associated with a more indolent clinical behaviour and a better overall survival than AR-EBVLPD. Extranodal involvement was higher in PBL-E (50%) than AR-EBVLPD; notably, the nasal cavity was affected most frequently in PBL-E (60%). Immunoglobulin heavy chain/(IGH)/MYC translocation was detected in half of the PBL-E cases. PBL-E shares some clinical features with AR-EBVLPD, such as HIV negativity, old age, and EBV infection, no known immunosuppressive condition but there are some differences such as a higher ratio of extranodal involvement and better prognosis. PBL-E is a newly recognized condition and should be distinguished from HIV-positive PBL, sharing features with AR-EBVLPD in particular, immunosenescence of the elderly.

Modelling the spread of HIV/AIDS epidemic in the presence of irresponsible infectives

In this study, a non-linear mathematical model was proposed and analyzed to study the effect of irresponsible infectives in the spread of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in a variable size population. The population was divided into four subclasses, of susceptibles (HIV negatives who can contract the disease), irresponsible infectives (people who are infected with the virus but do not know or live irresponsible life styles) , responsible infectives (HIV positives who know they are infected and are careful) and full-blown AIDS patients. Susceptibles were assumed to be infected through sexual contact with infectives and all infectives develop AIDS at a constant rate. Stability analysis and numerical simulations of the resulting model are presented. The model analysis shows that the disease-free equilibrium is always locally asymptotically stable and in such a case the basic reproductive number R0 1, the endemic equilibrium exists and the disease remains in the system. It is shown that the endemicity of the disease is reduced when irresponsible infectives become responsible.

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.

Drug injecting and syringe use in the HIV risk environment of Russian penitentiary institutions: qualitative study

Evidence highlights the prison as a high risk environment in relation to human immunodeficiency virus (HIV) and hepatitis C virus (HCV) transmission associated with injecting drug use. We undertook qualitative studies among 209 injecting drug users (IDUs) in three Russian cities: Moscow (n = 56), Volgograd (n = 83) and Barnaul in western Siberia (n = 70). Over three-quarters (77%) reported experience of police arrest related to their drug use, and 35% (55% of men) a history of imprisonment or detention. Findings emphasize the critical role that penitentiary institutions may play as a structural factor in the diffusion of HIV associated with drug injection in the Russian Federation. While drugs were perceived to be generally available in penitentiary institutions, sterile injection equipment was scarce and as a consequence routinely shared, including within large groups. Attempts to clean borrowed needles or syringes were inadequate, and risk reduction was severely constrained by a combination of lack of injecting equipment availability and punishment for its possession. Perceptions of relative safety were also found to be associated with assumptions of HIV negativity, resulting from a perception that all prisoners are HIV tested upon entry with those found HIV positive segregated. This study shows an urgent need for HIV prevention interventions in the Russian penitentiary system.

Factors Associated With Self-Risk Perception for Sexually Transmitted Diseases Among Adolescents

Sexually transmitted disease (STD) and human immunodeficiency virus (HIV) prevention efforts focus on increasing people’s awareness of their risks for these infections. Prevention programs have relied on the concept that perceptions of risk for negative consequences are critical in motivating protective health behavior. Perceptions of risk for STD defined here as the likelihood that a negative outcome (e.g. disease) will occur within 6 months after having unprotected sexual intercourse are presumed to influence subsequent sexual behaviors. We have previously shown that adolescents make decisions regarding their sexual behavior based on their perceived risk for STDs (PRSTD) and that PRSTD can predict subsequent condom use with a main sex partner. The objective of this study was to determine whether PRSTD is correlated with perceptions about partners’ STD-related risk behaviors. Prevention interventions include a focus on the role of sex partners in risk for acquiring an STD and it would be useful to know whether PRSTD is affected by perceptions about partners. Our sample consisted of adolescents who were participating in a longitudinal study at a municipal STD clinic. Eligibility criteria included: aged between 14 and 19 years old English-speaking ability engagement in vaginal or anal intercourse in the preceding 3 months HIV negativity and residence in the local metropolitan area. (excerpt)

Oro‐facial lesions and CD4 counts associated with HIV/AIDS in an adult population in Oyo State, Nigeria

The objective of this study was to define the oro-facial lesions associated with Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) in an adult population in Oyo state, Nigeria and to relate these with the level of immune suppression as measured by the CD4 counts. The study population consisted of 679 consecutive subjects who were seen at the state-owned blood bank. Information on demography, medical and medication histories were obtained. Oro-facial examinations were carried out according to Greenspan et al [Oral Surg Oral Med Oral Pathol (1992)73:142-144]. HIV sero-prevalence status was determined for all patients. CD4+ T-lymphocyte count was carried out for those sero-positive for HIV and 31 randomly selected HIV-negative subjects. Data were analyzed using the chi-square test, Fisher's exact test, Student's t-test and odds ratio where appropriate. Eighty-one (11.9%) of the entire study sample were confirmed HIV positive. The prevalence of specific oral lesions by HIV sero-status revealed that pseudomembranous oral candidiasis and angular cheilitis occurred significantly and more frequently in HIV-positive subjects (33.3 and 21% respectively) than those who were HIV negative (4.3 and 1.8% respectively, P < 0.05). The mean CD4 count of the HIV-positive subjects was 452 cells mm(-3), s.d. 137, while it was 602 cells mm(-3), s.d. 251, for the HIV negatives. The difference was statistically significant (P = 0.000). Forty-four (66.7%) subjects with CD4 counts <500 cells mm(-3) had oro-facial lesions whereas among those with CD4 counts >500 cells mm(-3) only 22 (33.3%) had oro-facial lesions (OR = 4.57). The type of oro-facial lesions most commonly associated with HIV/AIDS in Oyo state, Nigeria, has been shown to be pseudomembranous oral candidiasis. This was followed by angular cheilitis. These lesions, although found in HIV-negative subjects, were in a lower proportion as compared with HIV-positive subjects. Mean CD4 counts were lower in HIV-positive subjects and this was associated with greater prevalence of oro-facial candidiasis and angular cheilitis.

HIV infection and cocaine use in methadone maintained and untreated intravenous drug users

In a survey of 424 intravenous drug users (IVDUs) of whom 107 were currently enrolled in a methadone maintenance program (MMP), we assessed risk behaviors for Human Immunodeficiency Virus (HIV) transmission and conducted HIV testing. We found that African Americans were over-represented in the HIV infected group and under-represented in the methadone maintenance treatment group. Furthermore, subjects in current methadone maintenance treatment reported fewer drug injections in the last 30 days, a reduced speedball (a heroin/cocaine mixture) injection frequency and reduced total cocaine and injected cocaine use. HIV infected subjects reported 20% more cocaine use and injected cocaine use than HIV negatives. However, this difference was due to African Americans reporting more cocaine use and at the same time being over-represented in the HIV infected group. Stratified analysis by ethnicity found significant MMP effects for all ethnic groups, but only one significant HIV status effect, and this was limited to African Americans. Cocaine injection frequency in African Americans was significantly higher for the HIV infected versus non-infected subjects. We conclude that i.v. cocaine use is a risk factor associated with HIV infection and that methadone maintenance treatment is associated with reducing this risk factor. Furthermore, African American cocaine users are at great risk for HIV infection, and increased efforts for engagement in treatment are necessary.

AIDS-associated Illness and HIV Negativity

Letters1 December 1992AIDS-associated Illness and HIV NegativityRamon A. Torres, MD, Michael R. Barr, BSRamon A. Torres, MDSearch for more papers by this author, Michael R. Barr, BSSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-117-11-973_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editors: In light of recent cases of idiopathic CD4 T-lymphocytopenia (1), we report a case of an acquired immunodeficiency syndrome (AIDS)-associated illness in a human immunodeficiency virus (HIV)-seronegative man with disseminated measles infection.In April 1991, a 25-year-old homosexual man presented with 1-week history of a morbilliform skin eruption accompanied by fever, nonproductive cough, dyspnea, and lethargy. The patient had emigrated from Venezuela and had never received measles immunization. Five months before the onset of illness, he had tested negative for HIV-1 antibodies by enzyme immunoassay (EIA).Physical examination was remarkable for a temperature of 40 °C, oral...