Human Immunodeficiency Virus Positive Cases Research Articles

A capture-recapture modeling framework emphasizing expert opinion in disease surveillance.

In disease surveillance, capture-recapture methods are commonly used to estimate the number of diseased cases in a defined target population. Since the number of cases never identified by any surveillance system cannot be observed, estimation of the case count typically requires at least one crucial assumption about the dependency between surveillance systems. However, such assumptions are generally unverifiable based on the observed data alone. In this paper, we advocate a modeling framework hinging on the choice of a key population-level parameter that reflects dependencies among surveillance streams. With the key dependency parameter as the focus, the proposed method offers the benefits of (a) incorporating expert opinion in the spirit of prior information to guide estimation; (b) providing accessible bias corrections, and (c) leveraging an adapted credible interval approach to facilitate inference. We apply the proposed framework to two real human immunodeficiency virus surveillance datasets exhibiting three-stream and four-stream capture-recapture-based case count estimation. Our approach enables estimation of the number of human immunodeficiency virus positive cases for both examples, under realistic assumptions that are under the investigator's control and can be readily interpreted. The proposed framework also permits principled uncertainty analyses through which a user can acknowledge their level of confidence in assumptions made about the key non-identifiable dependency parameter.

Utility of bone marrow examination (BME) in the diagnosis of pyrexia of unknown origin (PUO).

Bone marrow examination (BME) is a useful tool in the diagnosis of haematological and non-haematological diseases. It plays an important role in early diagnosis of the underlying cause of pyrexia of unknown origin (PUO) and can influence the management of patients. Bone marrow aspiration (BMA) plays a very important role in establishing a definitive diagnosis in cases of PUO. The aim of this study was to review the indications and usefulness of bone marrow aspirates sent for microbiological evaluation as a diagnostic tool with histopathological correlation. A prospective study was conducted from 1 January 2017 to 30 September 2019 in the Department of Microbiology and Pathology on the bone marrow aspirates of patients of all groups. A total of 148 bone marrow aspirates were included. The cases were categorized as classical PUO (n = 81/148, 54.7%), nosocomial PUO (n = 4 /148, 2.7%), neutropenic PUO (n = 18/148, 12.1%), and immunocompromised PUO (n = 45/148, 30.4%), among which were systemic lupus erythematosus cases n = 8/45 (22.2%), human immunodeficiency virus positive cases n = 10/45 (17.7%), and renal transplant cases n = 27/45 (60%). A total of 28 BMAs were positive for microorganisms, out of which bacterial pathogens were n = 12 (42.8%), mycobacterial n = 12, 42.8%, fungal (n = 3, 10.7 %), and viruses (n = 1, 3.5%). This study helped in highlighting the role of bone marrow examination as an important diagnostic method in the diagnosis of infectious diseases.

Disease burden among migrants in Morocco in 2021: A cross‑sectional study.

Morocco, traditionally an emigration country, has evolved into not only a transit country to Europe but also a country of residence for an increasing number of migrants, with 102,400 migrants in 2019. This is due to its geographic location, the induced effects of its "African policy," and the various laws adopted by Moroccan legislators in recent years. The purpose of this study is to determine the prevalence of communicable and noncommunicable diseases among migrants such as Hepatitis C virus (HCV), human immunodeficiency virus (HIV), diabetes, and hypertension. We conducted a cross-sectional study in Oujda, Morocco, between November and December 2021. Face-to-face interviews with enrolled migrants aged 18 years and over, present in Oujda and attending an association, were carried out to collect socio-demographic data, lifestyle behaviors, and clinical parameters. Diabetes and hypertension were the primary outcomes. The Pearson's chi-squared test and the student's t-test were used to assess the bivariate associations between primary outcomes and categorical and continuous variables. In a multivariate model, we adjusted for predictors that were significant (p-value ≤0.05) in bivariate analysis to estimate Adjusted Odd Ratios (AOR) and 95% confidence intervals (CI). There were 495 migrants enrolled, with a male/female ratio of two and an average age of 27.3±11.5 years (mean±standard deviation), ranging from 18 to 76 years. Hepatitis C virus, human immunodeficiency virus, diabetes, and hypertension were found in 1%, 0.2%, 3.8%, and 27.7% of the population, respectively. Family history of diabetes was a risk factor for diabetes in the Oujda migrant population, with an Adjusted Odds Ratio (AOR) of 5.36; CI% [1.23-23.28]. Age (AOR of 1.1; CI% [1.06-1.13]) and African origin (AOR of 3.07; CI% [1.06-8.92]) were identified as risk factors for hypertension. Migrants in Oujda are healthy. The high prevalence of hypertension, as well as the presence of HCV and HIV positive cases, emphasizes the importance of routine screening for hypertension, HCV, and HIV in order to detect and treat these diseases as early as possible.

Effect of HIV status and antiretroviral treatment on treatment outcomes of tuberculosis patients in a rural primary healthcare clinic in South Africa.

Tuberculosis (TB) remains the leading cause of death among human immunodeficiency virus (HIV) infected individuals in South Africa. Despite the implementation of HIV/TB integration services at primary healthcare facility level, the effect of HIV on TB treatment outcomes has not been well investigated. To provide evidence base for TB treatment outcome improvement to meet End TB Strategy goal, we assessed the effect of HIV status on treatment outcomes of TB patients at a rural clinic in the Ugu Health District, South Africa. We reviewed medical records involving a cohort of 508 TB patients registered for treatment between 1 January 2013 and 31 December 2015 at rural public sector clinic in KwaZulu-Natal province, South Africa. Data were extracted from National TB Programme clinic cards and the TB case registers routinely maintained at study sites. The effect of HIV status on TB treatment outcomes was determined by using multinomial logistic regression. Estimates used were relative risk ratio (RRR) at 95% confidence intervals (95%CI). A total of 506 patients were included in the analysis. Majority of the patients (88%) were new TB cases, 70% had pulmonary TB and 59% were co-infected with HIV. Most of HIV positive patients were on antiretroviral therapy (ART) (90% (n = 268)). About 82% had successful treatment outcome (cured 39.1% (n = 198) and completed treatment (42.9% (n = 217)), 7% (n = 39) died 0.6% (n = 3) failed treatment, 3.9% (n = 20) defaulted treatment and the rest (6.6% (n = 33)) were transferred out of the facility. Furthermore, HIV positive patients had a higher mortality rate (9.67%) than HIV negative patients (2.91%)". Using completed treatment as reference, HIV positive patients not on ART relative to negative patients were more likely to have unsuccessful outcomes [RRR, 5.41; 95%CI, 2.11-13.86]. When compared between HIV status, HIV positive TB patients were more likely to have unsuccessful treatment outcome in rural primary care. Antiretroviral treatment seems to have had no effect on the likelihood of TB treatment success in rural primary care. The TB mortality rate in HIV positive patients, on the other hand, was higher than in HIV negative patients emphasizing the need for enhanced integrated management of HIV/TB in rural South Africa through active screening of TB among HIV positive individuals and early access to ART among HIV positive TB cases.

Isoniazid and Rifampicin Tuberculosis Drug Resistance in HIV Endemic Region of Western Kenya

Background: Tuberculosis drug resistance is often associated with inadequate anti-tuberculosis treatment regimen resulting to mutations that confers resistance to anti-tuberculosis agents. This is aggravated by synergetic relationship between Tuberculosis and HIV (Human Immunodeficiency Virus). Over 25% of Global Tuberculosis deaths occur in Africa and Kenya is one of the 30 high burden countries that together account for more than 80% of the world’s TB cases. According to World Health Organization, in 2018, Multi drug resistant Tuberculosis prevalence in Kenya was 1.3% in new cases and 4.4% in retreatment cases. Kisumu County recorded the second highest HIV prevalence at 18.6% against the national prevalence of 4.5% in 2020. The extent of regional burden of DR-TB and HIV co-infection has not been exactly well-defined in Western Kenya. Methods: This was a prospective cross sectional study that aimed to explore the association between Tuberculosis drug resistance and HIV status among new and previously treated pulmonary tuberculosis cases in Kisumu County, Kenya. Tuberculosis clinical suspects were recruited into the study and classified as HIV positive or negative based on their clinical data. Sputum samples from tuberculosis clinical suspects were subjected to fluorescent microscopy, phenotypic culture and line probe assay. Results: Out of a sample of 256, response rate was 216 of which HIV positive cases were 119(55.1%) and negative were 97 (44.9%). The study found that out of 11 that were phenotypic Isoniazid resistance 8(6.7%) were from HIV positive cases while 3 (3.2%) were from HIV negative cases. Phenotypic rifampicin resistance among the HIV positive were 8 (6.7%) while HIV negative were 2 (2.1%). All the 2(1.7%) MDR cases were from HIV positive participants. The study found out that HIV status and Tuberculosis cases were significantly associated at p<.05. HIV positive cases were more likely associated with retreatment cases (OR=1.4,95CI:1.00-1.90) compared to new cases. The study found out that the common mutant probe among the HIV positive was katG MUT1 4(2.6%), while mutant probes among the HIV negative were in hA MUT1 1(0.7%), katG MUT1 1(0.7%) and roB MUT2A 1(0.7%). Wild type gene deletion among the HIV positive cases were observed in probes katG WT 3(2.1%), roB WT7, katG WT 1(0.7%) while wild type gene deletion among the HIV negative cases were inhA WT1 1(0.7%), in hA WT1/inhAWT2 1(0.7%), katG WT 1(0.7%). Conclusion: Interventions specific to HIV-endemic areas are urgently needed to block tuberculosis drug resistance transmission. Development and improvement of the efficacy of interventions will require a greater understanding of the transmission of multidrug-resistant tuberculosis in HIV-endemic settings like Kisumu County, Western Kenya.

Evaluation of the HIV drug resistance surveillance system in Mozambique, 2017-2018

In the past ten years, the prevalence of primary Human Immunodeficiency Virus (HIV) drug resistance has ranged from zero to 25%, with higher and increasing rates in countries with access to antiretroviral therapy (ART), a specific case in Mozambique. World Health Organization (WHO) recommended that countries implement and routinely evaluate representative HIV drug resistance (HIVDR) research to monitor the emergency and transmission of HIV drug resistance mutations. This study aimed to describe the functioning of the system and also to identify gaps in the sensitivity, representativeness and quality of the data using the WHO methodology for Pre-Treatment and Acquired Approaches. We conducted a descriptive evaluation of the information system for surveillance of HIVDR in Mozambique in 2017-2018, based on updated guidelines for evaluating of public health surveillance systems from the Center for Disease Control and Prevention (CDC). The evaluation was conducted in all provinces using secondary data extracted from a cross-sectional survey database on HIVDR, with HIV positive cases at the beginning of ART aged ≥15 years. The system was described through informal conversations with HIVDR stakeholders and the simplicity, data quality and representativeness attributes were evaluated. With 322 positive cases at the beginning of ART (mean age=32.5 years, SD±11.1), about 63.0% (203/322) cases were women and 37.6% (121/322) men. The system was implemented in 25 health facilities distributed across all 11 Mozambican provinces and was considered representative. The system used two data collection instruments, the ART book and the form accompanying samples sent to the reference laboratory. The ART form, with 27 variables, was sent offline at two levels (health facility and National Institute of Health (NHI)), accompanied by dried blood spot samples for viral load testing and genotyping in the NHI virology laboratory, and was considered simple according to the standardized criteria. The system´s data quality was considered regular at 79.9%, with about 59.8% (1156/1932) of variable fields completed and 100% (1932/1932) consistency. The system used a single national laboratory to measure the prevalence of resistance to HIV drugs and was considered simple, with regular quality and representative data. We recommended public health efforts such as conducting genotyping tests be expanded to the provincial level, and periodic monitoring of system´s data collection procedures using forms.

Association of serum vitamin B12 with immuno-hematological parameters in treatment-naive HIV positive cases.

The manifestations of human immunodeficiency virus (HIV) infection and vitamin B12 deficiency overlap each other, so early diagnosis and intervention is important. The study aims to find out serum vitamin B12 level and its association with CD4 and CD8 count, clinical-staging, and hemato-biochemical status in newly diagnosed HIV positive cases. Fifty-five confirmed HIV cases above 18 years of age and equal number of age and sex matched controls were recruited for the study. CD4 and CD8 counts were analyzed by Flow cytometer. Complete Blood Count, Serum vitamin B12, Folic acid, ferritin, and C-Reactive Protein (CRP) concentration were done. Serum vitamin B12 was observed to be significantly low in HIV positive cases than healthy controls with a mean value of 240.62 ± 56.75 pg/ml and 317.57 ± 52.56 pg/ml, respectively. Decreased CD4 counts with elevated levels of ferritin and CRP was seen in HIV positive individuals. The subgroup analysis based on the levels of vitamin B12 was directly proportional to CD4 counts. CD8 counts also registered a significant association with serum B12 level, yet the response is not proportionate with the level of vitamin B12 deficiency. Nearly one-third of HIV positive cases revealed vitamin B12 deficiency. During the early stage, fast dividing immune cells cause increased consumption of micronutrients contributing toward vitamin B12 deficiency. It contributes to disorders in methylation affecting the immune function and NK Cell activity which increases the number of CD8 cells. Hence, vitamin B12 is a beneficial immunological modulator of HIV infection and can be a potent game changer in resource constrained set up.

A Study on HIV, Hepatitis B and Hepatitis C among Dental Patients Screened from Different Districts of Kashmir Valley

Background: Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) are the most common chronic viral infections worldwide. They are blood borne infections and share common routes of transmission, but they differ in efficiency by which certain types of exposures transmit them and their prevalence by geographic region. Aims and objective: To evaluate the prevalence of HIV, hepatitis B and hepatitis C in patients screened from different districts, to increase the awareness among dental practitioners and the patients attending dental clinics as well as to evaluate the risk factors for infection with these viruses in order to reduce the burden of these diseases in the community. Materials and method: A descriptive cross-sectional study was carried out on 2150 subjects (1230 males and 920 females) reported in the Department of Oral Pathology, GDC & H Srinagar for routine serological investigations. All the screened patients referred from different departments of this institution were enrolled. Results: The prevalence of HBV and HCV among dental patients was 0.65% and 0.51% respectively but HIV positive cases had not been reported. In the present study, majority of the HBV positive cases were from Anantnag district and most common risk factors for infections were dental treatment and blood transfusion. Conclusion: Prevention is an important aspect in controlling the spread of this viral infection as an epidemic. Hence, control programs for the prevention of these diseases that threaten public health must be planned and implemented. Keywords: Hepatitis B, HIV, Seroprevalence, Dental treatment, Transmission, Prevention.

Prevalence of Tuberculosis and Human Immunodeficiency Virus (HIV) in Ikere-Ekiti, Ekiti State Southwestern Nigeria

Tuberculosis (TB) and human immunodeficiency virus (HIV) are major devastating infectious diseases African countries and other regions of the world. TB is a potentially serious infectious bacterial disease that mainly affects the lungs. While HIV is a virus that attacks the body's immune system; which if left untreated, can lead to acquired immunodeficiency syndrome (AIDS). Thus, this study was carried out to monitor the prevalence of tuberculosis and human immunodeficiency virus (HIV) situation in Ikere-Ekiti, Ekiti State Southwestern Nigeria. A total of 191 participants were enrolled in this study. Blood and sputum samples were used in screening of HIV and Mycobacterium tuberculosis respectively. 102(53.4%) participants were confirmed HIV positive cases and 89(46.6%) participants were confirmed as M. tuberculosis-positive cases. The rate of tuberculosis was higher among women than among men and prevalence of HIV was slightly higher among men than among female. The study shows that age group 26 – 30 years have the highest rate of tuberculosis and age group 36 – 40 years have the highest rate of HIV cases while the highest number of TB with HIV co-infection 34 (17.8%) were gotten from the age group 36 – 40years. The rate at which the prevalence of tuberculosis, HIV and their co-infection are rising is due to various challenges facing its eradication. Adequate resource mobilization and effective spending is needed to achieve success. In addition, efforts should be made to improve the surveillance system.

HIV Co-Infection Among Presumptive Tuberculosis Cases and Asthmatic Patients at University of Gondar Hospital, Northwest Ethiopia.

Tuberculosis and Human Immunodeficiency Virus (HIV) have been closely linked since the emergence of Acquired Immunodeficiency Syndrome (AIDS). Several studies have suggested an increased incidence of asthma among HIV positive individuals. This study aimed to determine the prevalence of Mycobacterium tuberculosis (MTB) and HIV infection among presumptive tuberculosis cases and asthmatic patients. A hospital-based, cross-sectional study was conducted on 424 study participants from October 2018 - June 2019. Sociodemographic data and sputum samples were collected and investigated by Ziehl-Neelsen microscopy, Gene Xpert MTB/RIF assay, and culture. The nutritional status of the patients was assessed by body mass index. Finally, data was entered, cleared, and checked using Epi-info version 7 and exported to SPSS version 20 for analysis. Logistic regression was used for statistical association. p-value < 0.05 at 95% CI was considered statistically significant. The overall prevalence of MTB and HIV infection was 3.86% and 5.4%, respectively. The prevalence of MTB infection among presumptive tuberculosis (TB) cases was 4.4%, but none among asthmatic patients. The prevalence of HIV infection among presumptive TB cases and asthmatic patients was 5.2% and 6.6%, respectively. The overall prevalence of malnutrition was 30%. The prevalence of malnutrition among culture-positive TB patients was 31.25% and that of HIV positive cases was 43.5%. The proportion of MTB infection among HIV positive patients was 12.5%. Marital status of the study subjects significantly associated with culture positive MTB infection. Occupation and previous history of tuberculosis infection had a statistically significant association with HIV infection. This study showed a high prevalence of HIV among asthmatic patients compared to presumptive TB cases. So, regular large-scale surveys should be conducted to assess the burden and intervene accordingly.

A Predictive Test in The Screening of HIV Positive Cases; Interferon Gamma Inducible Protein 10 (IP-10).

HIV (human immunodeficiency virus), causing acquired immunodeficiency syndrome (AIDS), is one of the most important health problems in the world. Certain cytokines produced during the cytokine storm in an acute infection can be biomarker candidates. The strong association of IFN-γ inducible protein 10 (IP-10) with low CD4 cell counts suggests that it can be an acute phase biomarker. In this study, IP-10 was monitored at routine controls during pre-treatment and/or in subsequent phases of treatment, and its correlation with CD4 cell count and viral load was assessed. Venous blood samples, taken from 30 patients (at 0 - 3 - 6 months), and 20 healthy volunteers, were sent to the Laboratory for flow cytometry, nucleic acid tests (NAT) and ELISA tests. The mean IP-10 concentration of patients was 344 pg/mL, and these values for the untreated, treated and control groups were 422 pg/mL and 210 pg/mL and 68 pg/mL respectively. A statistically significant difference was found between the IP-10 values of the patient and control groups (p = 0.006). There was a significant, positive and moderate relation between IP-10 and viral load values (r = 0.59, p < 0.001), while there was a significant, negative and moderate relation between IP-10 and CD4 cell count (r = -0.51, p < 0.001). IP-10 levels in early HIV-1 patients, which are shown to be closely related to CD4 cell levels and viral replication, may be an alternative or support marker compared to the more expensive viral load tests in monitor-ing viremia changes and response to antiretroviral treatment.

HBV co-infection in HIV infected patients and its effect on progress of the disease

Introduction: Co-infection of Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) is a common event due to similar routes of transmission, with significant clinical implications. Progression to liver disease is more rapid in HIV-HBV co-infected patients. The present study was designed to find the sero-prevalence of HBV in newly diagnosed HIV positive patients. Materials and Methods: 200 newly diagnosed HIV positive cases were enrolled in present study. 3-5 cc blood was collected from these patients and HBsAg ELISA was carried out on serum obtained. HBsAg positive samples were processed further to detect HBeAg and anti-HBeAg by ELISA. Liver Function Tests (LFTs) and CD4 T cell count were noted. Results: Out of 200 HIV positive patients, 4% were co-infected with HBV. Out of the 4% co-infected cases 37.5% were HBeAg positive and 62.5% were anti-HBe positive None of the HIV-HBV co-infected case had a CD4 T-cell count >500 cells/µL whereas 55.2% of HIV mono-infected cases had CD4 T-cell counts > 500 cells/µL. 37.5% HIV-HBV co-infected cases had CD4 T-cell count ≤200 cells/µL whereas only 11.4% HIV mono-infected cases had CD4 T-cell count ≤200 cells/µL.HIV-HBV co-infected cases had more deranged liver enzymes. 50% of HIV-HBV co-infected cases belonged to WHO stage II, whereas majority (91.6%) of HIV mono-infected cases belonged to WHO stage I. Conclusion: This study highlights that, routine screening of HBsAg should done in all HIV infected patients and virological markers of HBV, Liver Function Tests and CD4 T cell count of HIV-HBV co-infected patients should be assessed for appropriate management. Keywords: HIV-HBV Co-infection-Correlation: CD4 Count, WHO staging, LFT.

Development of High Resolution Melting Analysis as a Diagnostic Tool for Molecular Detection of Toxoplasma Infection in Pregnant Women and HIV Positive Cases.

Background:Toxoplasma gondii is an obligate intracellular protozoan with worldwide distribution. Diagnosis of toxoplasmosis is a very critical issue, especially in pregnant women and immunocompromised patients. The aim of this study was rapid detection of T. gondii DNA in peripheral blood samples (PBS) employing HRM technique and using RE gene.Methods:Totally, 242 samples from pregnant women and human immunodeficiency virus (HIV) patients were collected from different hospitals and medical centers of Tehran during Oct 2017 to Dec 2018. High resolution melting analysis (HRM) using partial sequences of repetitive element (RE) gene was done and compared with ELISA test.Results:Overall, 51 were positive for acute toxoplasmosis that among them, 12 and 20 reported as positive in pregnant women and HIV+ patients, respectively using HRM technique. Among 70 patients in chronic phase of disease, 10 and 3 samples were reported as positive for pregnant women and HIV+ patients respectively. From 121 negative control, 3 (4.62%) samples associated with HIV+ patients, showed positive real-time PCR and HRM analysis results.Conclusion:For the first time, HRM technique via employing RE gene was used for detection of T. gondii infection in PBS. This method is suitable, helpful and in parallel with serological methods for early diagnosis of acute as well as active form of toxoplasmosis in pregnant women and HIV+ patients. The use of techniques based on melt curve and through employing next-generation dyes for diagnosis of T. gondii would be accessible for patients in developing countries.

Prevalence and Characteristics of Neuroinfectious Disease Inquiries Within the Emerging Infections Network: A 22-Year Retrospective Study.

BackgroundTo monitor emerging infectious diseases, the Centers for Disease Control and Prevention and the Infectious Disease Society of America established the Emerging Infections Network (EIN), allowing infectious disease specialists to post inquiries about clinical cases. We describe the frequency and characteristics of neuroinfectious disease-related inquiries.MethodsThe EIN listserv was retrospectively reviewed from February 1997 to December 2019 using search terms associated with neurologic diseases. We recorded case summaries, disease type (ie, meningitis, encephalitis), inquiry type (diagnostic approach, result interpretation, management decisions), unique patient populations, exposures, pathogens, ultimate diagnosis, and change in clinical care based on responses.ResultsOf 2348 total inquiries, 285 (12.1%) related to neuroinfectious diseases. The majority involved meningitis (99, 34.7%) or encephalitis (56, 19.6%). One hundred fifteen inquiries (40%) related to management, 34 (12%) related to diagnostic workup, and 22 (8%) related to result interpretation. Eight (2.8%) specifically involved results of cerebrospinal fluid polymerase chain reaction testing. Sixty-three (22.1%) involved immunosuppressed patients (29 human immunodeficiency virus-positive cases [46%]). The most common pathogens were Treponema pallidum (19, 6.7%) and Cryptococcus neoformans (18, 6.3%). In 74 (25%) inquiries, patients had neurologic symptoms without a clear infection, 38 (51.3%) of which included noninfectious neurologic etiologies in the differential diagnosis.ConclusionsThis study demonstrates the significant challenges of diagnosis and management of neuroinfectious diseases within the field of infectious diseases. It also highlights the importance of curated forums to guide the approach of difficult cases, in particular instances that mimic infectious diseases. Finally, the EIN listserv may assist in identifying areas for research and training to address these complexities.

Prevalence of Transfusion Transmissible Infections (HBV, HCV, HIV and Treponema pallidum in Volunteer Blood Donors in Shirajganj District

Blood and its components are essential for life and often required to be transfused in critical health condition. However, such transfusion is reported to be associated with the risk of transfusion transmissible infections (TTIs) with notable pathogens e.g. Hepatitis B virus (HBV), Hepatitis C virus (HCV), Human immunodeficiency virus (HIV) and Treponema pallidum. These pathogens are of major public health concern especially in developing countries like Bangladesh. Increase in the number of TTIs is found to be associated with improper management of safe blood transfusion protocol (SBTP) and unethical practices. This study focuses on the prevalence of such TTIs in volunteers’ blood collected between October and December 2018 from Sakhawath Memorial and Avicina Hospitals in Shirajgong district. Prevalence rate of HIV, HBsAg, HCV and Treponema pallidum were 1.2%, 6.8%, 0.8% and 1.6%, respectively. Among the infected individuals, 75% HIV positive cases were professionals, 70% HCV infected cases wwere from other professional groups and 50% of syphilis infected were homemakers. Male donors showed higher incidence rate of HBV (65%), HCV (72%) and HIV (85%) compared to the female donors. Although the findings of the study showed prevalence of TTIs in volunteer blood donors (VBDs) at an alarming rate, most of the infected individuals were not aware of their infections and potential risk of transmission from them. It is necessary to create awareness among blood donors about possible causes of transmission and prevention of infection . Such initiative from both governmental and non-governmental organizations can help reduce TTIs among VBDs.&#x0D; Bangladesh J Microbiol, Volume 36 Number 2 December 2019, pp 105-109

Postmortem Molecular Epidemiology of HIV-1 Strains Isolated in Turkey

Human immunodeficiency virus (HIV) comprises two genotypes, namely HIV-1 (group M, N, O and P) and HIV-2 (group A to H), which differ in their envelope glycoproteins and other antigenic epitopes despite their morphological and biological resemblance.Group M of HIV-1 responsible for 95% of HIV infections worldwide is composed of nine subgroups. In addition to subgroups, group M contains also two recombinant forms, known as circulating recombinant form (CRF) and unique recombinant form (URF). The first case of HIV/acquired immun deficiency virus (AIDS) in Turkey was reported in 1985 and the current number of cases reached a total of 18.557 including 1736 with AIDS based upon the surveillance data of Ministry of Health between October 1985 and November 2018. The aim of this study was to determine the prevalence of HIV-1 strains isolated from HIV positive autopsy cases detected by HIV polymerase chain reaction (PCR) and determine drug resistance. Twenty eight cases [17 males, 11 female: age ranged between 3 months and 66 years (median: 35 years)] found to be HIV positive among the autopsy cases sent for HIV1 PCR study and serological screening between 2011-2017 were recruited in the study. For identification of subtypes in HIV-1 isolates, most-preferred analysis tool was used [HIVdb Stanford University Genotypic Resistance Interpretation Algorithm (www.hivdb.stanford.edu)]. Phylogenetic tree was made according to direct sequencing of HIV-1 reverse transcriptase (pol) region and phylogenetic analysis was evaluated in 23 cases. Los Alamos National Laboratory were trimmed from full-length genomes. Phylogenetic analysis of the 870 base pair of the pol gene region was performed using CLC Sequence Viewer v8.0 (Qiagen Aarhus A/S, www.qiagenbioinformatics.com) software. The phylogenetic tree was obtained according to the neighbor-joining method and the Jukes-Cantor nucleotide distance scale and bootstrap value was set at 1000. In our study, subtype B was found to be most frequent type (39.3%; 11/28). Subtype A (17.9%; 5/28), CRF02_AG (14.3%; 4/28), subtype C (10.7%; 3/28), B+CRF02_AG recombinant (3.6%; 1/28), CRF01_AE (3.6%; 1/28), subtype D (3.6%; 1/28), as well as subtype F (3.6%; 1/28) and subtype G (3.6%; 1/28) strains were also detected in the circulation. Analysis of our results showed that 32.1% (9/28) of the samples exhibited resistance mutations. Detected mutations were as follows: M41L, T215C, K65R, M184V, responsible for nucleoside reverse transcriptase inhibitor (NRTI) resistance; K103N, Y181C, G190A, responsible for non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance; D30N, M46I, responsible for protease inhibitor (PI) resistance. NRTI, NNRTI and PI mutation rates in the samples were found as 21.4%, 7.1% and 3.6%, respectively. Although number of samples analyzed in our study is low, we can propose that they resemble the strains circulating in Turkey. The results of our study; although the subtype B is still dominant in our country, it supports other studies reporting that there are non-B subtypes and an increase in CRF rates in recent years. Phylogenetic analysis is widely regarded as the gold standard technique to determine the subtypes of HIV-1. Molecular epidemiologic studies related to HIV may be important in monitoring HIV subtype patterns and spreading pathways in that country. As a result; the opportunity to collect postmortem HIV sequences in a database appears to have occurred, and as this database expands, its usability is available. Therefore, it is thought that HIV subtypes and mutation information may be useful.

HIV status among presumptive tuberculosis cases attending tertiary care centre in South India.

In India, to increase human immunodeficiency virus (HIV) case detection, the National Technical Working Group on TB /HIV had made it mandatory to screen for HIV infection among presumptive tuberculosis (TB) cases. Our study was a cross-sectional study, conducted between June 2015 and December 2016 in a tertiary care institute (JIPMER), in South India, to estimate the prevalence of HIV among presumptive TB cases. Among the 964 presumptive TB cases who attended pulmonary medicine OPD, 189 patients were sputum acid-fast bacilli (AFB) positive. Among the 189 sputum positive cases, 9 were HIV positive. Of the 964 presumptive TB cases, 879 gave consent for HIV testing and 33 (3.7%) turned out to be HIV positive. If only sputum positive cases had been screened for HIV, we would have missed 24 new HIV positive cases. The number needed to screen was 27 among presumptive TB cases and 18 among TB patients. The uptake of HIV testing (91%) and the diagnostic yield of 3.7% of HIV positive cases among the presumptive TB patients is quite high compared to that of the Revised National Tuberculosis Control Programme (RNTCP) mechanism of Puducherry. This reinforces the need to screen all the presumptive cases for HIV infection, to increase HIV case detection so that anti-retroviral therapy (ART) can be initiated early.

Assessing the impact of HIV status on injury outcomes: A multicenter study of trauma patients in Rwanda

BackgroundThere is conflicting evidence regarding the impact of human immunodeficiency virus serostatus on trauma outcomes in low-resource settings. This study sought to evaluate the impact of human immunodeficiency virus serostatus on mortality outcomes for Rwandan patients presenting after trauma. MethodsThis retrospective review of the University of Rwanda trauma registry captured all adult trauma patients with known human immunodeficiency virus status presenting between March 2011 and July 2015. Confirmed human immunodeficiency virus-positive cases were matched 1:2 with known human immunodeficiency virus-negative controls using a modified Kampala Trauma Score, sex, and district of residence or primary hospital. All-cause mortality was compared using multivariable logistic regression. ResultsIn total, 11,280 patients were recorded prospectively in the registry (169 human immunodeficiency virus positive; 334 human immunodeficiency virus negative matches). There was no difference in delay of hospital presentation or time until operation (P = .50 and P = .57, respectively). Less than 30% of all patients underwent operation during admission (n = 133), and the rate of operative intervention was independent of human immunodeficiency virus serostatus (P = .946). There was no association between development of any complication and human immunodeficiency virus status (P = .837). The overall mortality rate was 8.9% and 3.3% for human immunodeficiency virus-positive and human immunodeficiency virus-negative patients, respectively (P = .010). Human immunodeficiency virus positivity was associated with increased 30-day mortality when controlling for potential confounders (P = .016; odds ratio 3.60, 95% confidence interval: 1.27–10.2, C statistic 0.88). ConclusionBoth human immunodeficiency virus and trauma pose substantial public health threats in sub-Saharan Africa. Known human immunodeficiency virus seropositivity in Rwandan trauma patients is associated with early mortality. Further investigation regarding testing, treatment, and outcomes in human immunodeficiency virus-positive trauma patients is warranted and provides an opportunity for leveraging human immunodeficiency virus global health efforts in trauma outcomes assessment.

HIV/AIDS case definition criteria and association between sociodemographic and clinical aspects of the disease reported in the State of Minas Gerais from 2007 to 2016.

Over 30 years after the acquired immunodeficiency syndrome epidemic, several strategies have been implemented to verify the trend of the infection, the profile of the affected individuals, and the impact of prevention and control measures, with notification of asymptomatic carriers being the most recent measure. This study aimed to verify the geographic distribution of human immunodeficiency virus/acquired immunodeficiency syndrome and analyze the association between case definition criteria, sociodemographic data, and clinical aspects of the disease in the State of Minas Gerais between 2007 and 2016. In this ecological and analytical study, 35,349 cases of human immunodeficiency virus/acquired immunodeficiency syndrome reported in the State of Minas Gerais between 2007 and 2016 were analyzed. The data were analyzed using multiple correspondence factor analysis, time series analysis, descriptive statistics, and spatial distribution of the cases by macro-region. The majority of the patients were brown-skinned individuals, alive, diagnosed with human immunodeficiency virus/acquired immunodeficiency syndrome on the basis of the criteria adapted from the Centers for Disease Control and Prevention, and living in municipalities with more than 50,000 (80.5%) inhabitants. Between 2007 and 2016, there was an increase in the number of criteria used for diagnosing human immunodeficiency virus. By contrast, a consequent decrease was observed in the number of criteria used for defining cases, which were adapted from the Centers for Disease Control and Prevention, Rio de Janeiro/Caracas, and for identifying AIDS-related deaths. Young people aged between 13 and 29 years, individuals whose education level is compatible with the observed age, and homosexual men were associated with the HIV+ criterion. Out study showed that after the mandatory notification of human immunodeficiency virus-positive cases in 2014, there was a decrease in other criteria for defining human immunodeficiency virus/acquired immunodeficiency syndrome cases and changes in the profile of people living with human immunodeficiency virus/acquired immunodeficiency syndrome.

Efficacy of World Health Organization guideline in facility-based reduction of mortality in severely malnourished children from low and middle income countries: A systematic review and meta-analysis.

Globally more than 19 million under-five children suffer from severe acute malnutrition (SAM). Data on efficacy of World Health Organization's (WHO's) guideline in reducing SAM mortality are limited. We aimed to assess the efficacy of WHO's facility-based guideline for the reduction of under-five SAM children mortality from low and middle income countries (LMICs). A systematic search of literature published in 1980-2015 was conducted using electronic databases. Additional articles were identified from the reference lists and grey literature. Studies from LMICs where SAM children (0-59 months) were managed in facilities according to WHO's guideline were included. Outcome was reduction in SAM mortality measured by case fatality rate (CFR). The review was reported following the Grading of Recommendations Assessment Development and Evaluation and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and meta-analyses done using RevMan 5.3®. This review identified nine studies, which demonstrated reductions in SAM mortality. CFR ranged from 8 to 16% where WHO guideline applied. High rates of poverty, malnutrition, severe co-morbid condition, lack of resources and differences in treatment practices played a key role in large CFR variation. Most death occurred within 48 h of admission in Asia, between 4 days and 4 weeks in Africa and in Latin America. CFR was reduced by 41% (odds ratio: 0.59; 95% confidence interval: 0.46-0.76) when WHO guideline were applied. A 45% reduction in CFR was achieved after excluding human immunodeficiency virus positive cases. Dietary management also differed among WHO and conventional management. Children receiving SAM inpatient care as per WHO guideline have reduced CFR compared to conventional treatment.