Human Immunodeficiency Virus Positive Individuals Research Articles

FibroScan® versus Biochemical Scores: A Study of Liver Fibrosis in HIV with HBV Co-Infection.

The study aimed to determine liver fibrosis in human immunodeficiency virus (HIV) positive individuals using transient elastography (FibroScan®), Fibrosis-4 (FIB-4) score, and aspartate aminotransferase (AST) to Platelet Ratio Index (APRI) in the HIV Department from Infectious Diseases Hospital "Victor Babeș" Craiova, Romania. Of the analyzed HIV-positive subjects (n = 161), 93 (57.76%) had HIV mono-infection, and 68 (42.24%) had Hepatitis B Virus (HBV) co-infection. The prevalence of advanced liver fibrosis was higher (F2: 11.76% and F3: 13.24%, F4: 4.41%) in the HIV-HBV co-infected group compared to the HIV mono-infected group. The univariate and multivariate analysis identified HBV co-infection (OR = 5.73) male sex (OR = 5.34), serum aspartate amino-transferase levels (Pearson's rho = 0.273), low platelet count (Pearson's rho = -0.149) and erythrocyte sedimentation rate (OR = 1.030) as risk factors for the presence of liver fibrosis. Body mass index (OR = 1.08), serum lipid levels (OR = 0.96), viral load at diagnosis (OR = 1.00005), and low CD4+ cell count (OR = 0.977) were also correlated with liver fibrosis. The FIB-4 and APRI scores were strongly correlated with each other. In conclusion, HBV co-infection seems to be a determinant factor for liver fibrosis development in people living with HIV, together with other risk factors.

Clinicoradiological Profile of Patients Having Drug-Sensitive Pulmonary Tuberculosis With and Without Diabetes Mellitus in a Tertiary Care Hospital in Ahmedabad, Gujarat, India.

Background A significant effect of diabetes mellitus (DM) on the clinical and radiological features of tuberculosis (TB) has been reported. However, conflicting results have also been reported. Hence, a conclusion is yet to be drawn. This study aimed to analyze and compare the clinical and radiological features of drug-sensitive pulmonary TB with DM and without DM. Methodology A comparative, observational study was conducted between August and October 2023. Patients with drug-resistant TB, extrapulmonary TB, those on immunosuppressive drugs, and human immunodeficiency virus-positive individuals were excluded from this study. Pulmonary TB patients with DM were classified as the case group and those without DM were classified as the control group. Demographic details, clinical symptoms, detailed past and family histories of comorbid conditions, laboratory investigations, sputum acid-fast bacilli results, and chest X-ray findings were noted. The diagnosis of TB and grading of sputum smear results were done by following the National Tuberculosis Elimination Program guidelines. Results A total of 40 patients, 20 (50%) cases and 20 (50%) controls, were enrolled in this study. Clinical symptoms were almost similar in both groups except for dyspnea (80% vs. 40%) and hemoptysis (75% vs. 35%), which were significantly predominant in the case group. Lower zone involvement in chest X-ray was significantly (p = 0.0079) more in the case group (75%) compared to the control group (40%). Cavitary lesions were also significantly higher in the TB with DM group (p = 0.031). Bilateral lesions and multiple zone involvement were also more common in the case group, although no statistically significant difference was seen. Additionally, thehematological parameters of the two groups differed; however, the findings were not statistically significant. Conclusions Based on our findings, we recommend screening all TB patients for DM. Similarly, all high-risk DM patients should be screened for TB for early diagnosis and management, thereby reducing morbidity and mortality. Physicians should be aware that people with DM may present with pulmonary TB in an atypical manner.

Diabetes mellitus and associated risk factors among HIV infected patients on HAART

BackgroundUnderstanding the impact of disease associations is becoming a priority in Kenya and other countries bearing the load of infectious diseases. With the increased incidences of non-communicable diseases and the endemicity of infectious diseases in Sub-Saharan Africa, their co-existence poses significant challenges to patients, health workers and an overwhelmed health sector. Classical risk factors for diabetes such as physical inactivity and unhealthy diet may not solely explain the current trends, suggesting the role of novel risk factors including infections/inflammation. HIV and its treatment have been identified as potential contributors especially to patients with family history of confirmed diabetes cases. Co-infections frequently observed during HIV infection also significantly influence both the epidemiological and pathophysiological of the link between HIV and diabetes. Understanding the correlates of HIV and diabetes is crucial to inform management and prevention strategies of the twin infections. We therefore aimed to determine the prevalence of diabetes mellitus and risk factors in a population of HIV infected patients on HAART. This study determined the association of diabetes/impaired glucose regulation in the context of HIV-1. A cross-sectional study was conducted at a comprehensive care clinic in Nairobi (Kenya). Participants were screened for diabetes and impaired glucose regulation using random blood glucose and glycated haemoglobin (HbA1c) This paper describes the prevalence of diabetes mellitus in Human Immunodeficiency Virus positive individuals and the associated risk factors. We have demonstrated that family history is a risk factor for diabetes. While age and BMI are known risk factors, they were not associated with diabetes in this study.

Plasmablastic Lymphoma in Epstein–Barr Virus-negative Patient

Plasmablastic lymphoma is a rare and aggressive variant of diffuse large B-cell lymphoma. It often develops in immunocompromised patients, particularly in human immunodeficiency virus-positive individuals. This report highlights the development of such a rare, aggressive malignancy in an immunocompetent adult male with negative Epstein–Barr virus serology. The patient was diagnosed 6 months after the onset of neck and submandibular swelling. A pan-computed tomography scan revealed nodal and extranodal involvement of the iliac bone and iliacus muscle. Chemotherapy was planned, but the patient’s condition deteriorated and he died. This case helps us to understand the clinicopathological features of this malignancy in the Saudi population and may help in early detection and better prognosis.

Coinfection of HCV among HIV-infected patients: Across-sectional study in rivers State, Nigeria

Background: Hepatitis C virus (HCV) has emerged as the cause of the second major epidemic of viral infection after human immunodeficiency virus (HIV) within the past two decades. HCV is the cause of more than three-quarters of liver-relate deaths in HIV-seropositive individuals and it is remarkable that today approximately one-quarter of HIV-infected individuals Aim: this study aimed at determining the prevalence of coinfection patterns of HCV among HIV infected individual in Rivers State, Nigeria. Materials and methods: A retrospective survey conducted on 350 HIV infected individual attending ART clinic at Rivers State University Teaching Hospital, Port Harcourt, Nigeria. Sociodemographic data were collected based on interviewer-based questionnaire, and clinical history was obtained from participants' medical records. Antibody analyses for HCV were done using ELISA method. Results: The prevalence of hepatitis C virus coinfection among HIV positive individual was 6(4.0%), The prevalence of HCV and HIV positive individual with regards to age was high within the age of 21 -40 5(2.4%). Prevalence based on gender was females 4(1.1%) and males 2(1.4%), prevalence of HIV/HCV co-infection with respect to marital status was high among the single 6(4.9%), prevalence of HIV/HCV co-infection with respect educational status was high with tertiary 3(3.5%) than the secondary 3(1.6%). The prevalence among the different occupational groups, business had the highest co-infection rate (1.1%) followed closely by Working class (0.8%). Higher HIV/HCV co-infection was observed among those with CD4 cell count 350-499 cells/μl (4.6%). Conclusion: However, the low burden of this hepatotropic virus coinfection calls for continued need to screen for HCV among individual infected with HIV before the start of ART.

Some Coagulation and Haematological Parameters of Human Immunodeficiency Virus Positive Individuals Accessing Clinic in Haart Centers in Esan South-East Local Government Area of Edo State, Nigeria

Highly active antiretroviral therapy (HAART) has significantly reduced the scourge of Human Immunodeficiency Virus and its associated mortality, but systemic complications, haematological changes and other complications have been reported in patients receiving HAART (or ART).

Evaluation of Thyroid Function of HIV Patients in Umunze, Anambra State, Nigeria

Background: Abnormal thyroid function tests have been detected at various phases in people living with Human immunodeficiency virus (HIV) and the effect of highly active antiretroviral therapy (HAART) not well understood. However, there is insufficient study among Nigerians living with HIV.
 Objective: This study is aimed to determine thyroid hormones in HIV positive individuals compared with HIV negative individuals in Umunze, Anambra State, Nigeria.
 Materials and Methods: This cross-sectional study was carried out over a period of six months among 95 HIV positive and 30 HIV negative individuals attending USAID/FHI clinic of Immaculate Heart Hospital in Umunze, Nigeria. The subjects were divided into three groups on the basis of HAART (those on HAART [48] – GROUP 1, HAART naïve [47] – GROUP 2 and Control [30] – GROUP 3). The subjects were interviewed, examined and blood sample collected for determination of thyroid function parameters which include thyroid stimulating hormone (TSH), free triiodothyronine (fT3), triiodothyronine (T3), free thyroxine (fT4), and thyroxine (T4).
 Results: Among the 125 subjects recruited for the study 67.2% were females and 32.8% males. The mean levels of TSH and fT3 was found to be higher in group 1 subjects than in group 2 and the group 3 subjects. The mean level of T4 was significantly higher in group 2 subjects than group 1 and the group 3 subjects. The level of T3 was significantly lower in control subjects in comparison to both HAART and non-HAART subjects. Primary hypothyroidism is the commonest pattern of thyroid dysfunction among the HIV positive patients followed by isolated low fT4.
 Conclusion: Serum levels of thyroid hormones as shown in this study may be used as baseline periodic markers during antiretroviral therapy while people living with HIV may benefit from supplementation if appropriate. There is also need for a larger study to identify the risk factors for progression to overt thyroid disease in HIV infected subjects with thyroid autoimmunity.

Seroprevalence of Hepatitis B and C co-infection in HIV seropositive and HIV seronegative cases in a Tertiary care hospital in Southern Haryana

HBV (Hepatitis B virus) and HCV (Hepatitis C virus) are the causative agents of acute as well as chronic hepatitis. Nearly, two billion people are suffering with HBV and approximately 170 million people are infected with HCV infection around the world. While patients who are infected with HIV (Human Immunodeficiency Virus) 2-4 million are found to be having chronic HBV co-infection and 4-5 million are having HCV coinfection. Due to common mode of transmission of HIV, HBV and HCV like using shared needles, syringes, other injectable devices, sexual intercourse, or even mother to baby transmission, it is common to see HBV and HCV co-infection in HIV positive individuals. This was a hospital based observational cross-sectional study. This study was conducted in Department of Microbiology, SHKM GMC, Nalhar, Nuh, Haryana. It was for one year. The sample size for HIV seropostive cases was 80 including 40 HIV positive and 40 HIV negative samples. Seroprevalence of HBV and HCV was identified on HIV positive and HIV negative samples. Seroprevalence of HBV and HCV was found to be higher in HIV positive individuals than HIV negative individuals. In HIV positive patients 10% individuals were HBsAg positive, 5% were HBeAg positive, 10% were positive by HBV RT-PCR. None of the HIV negative were coinfected with HBV. Similarly HCV-HIV coinfection was seen in 12.5% of individuals with Rapid test, ELISA and RT-PCR. None of the HIV negative were coinfected with HCV. In HIV positive individuals HBV and HCV coinfection was seen and Co-infection of HBV and HCV was absent in HIV negative individuals. Regular screening is recommended for HBV and HCV in HIV positive individuals.

Assessment of Knowledge on HIV Screening Among Students in Girls' Secondary School Abayi, Aba, Abia State, Nigeria

Background: Voluntary counseling and testing is a vital element of Human Immunodeficiency Virus (HIV) prevention and care strategies worldwide. It is a test carried out to determine the HIV status of a person. HIV screening enables early detection and initiation of treatment which improves the quality, and life expectancy of a HIV positive individual. Adolescents are among the vulnerable groups with an increased risk of exposure to HIV/AIDS and need to embrace HIV/AIDS testing and counseling. Objective: To assess the knowledge on HIV screening amongst adolescents in Girls’ Secondary School Abayi with a view to enlighten them on the importance of HIV screening. Materials and Methods: It was a descriptive cross-sectional study and semi-structured questionnaire was used for data collection. Students within the ages of 10-19 years were selected by systematic sampling methods and 424 students were presented using tables. Association was tested at p-value of 0.05%. Results: There was a non-response rate of 20 (4.7%). Two-hundred and thirty-four (57.9%) of the students had good knowledge of HIV/AIDS screening and 282 (69.8%) knew that HIV screening is a test to determine individual HIV status. Uptake of HIV screening was 57(14.1%) and 178 (44.1%) students believed that the reason for poor HIV screening was lack of proper awareness. Benefits of HIV screening included helping to start early treatment as accepted by 191 (47.3%) students and 332 (82.2%) respondents agreed that the test provided opportunity for proper advice on knowledge of HIV. Association of class of the respondents and knowledge HCT was found to be statistically significant with p-values of 0.006. Conclusion: There was a good knowledge of HIV screening among the students. The major reason for poor screening uptake were lack of awareness on HIV screening and inadequate provision of screening opportunities. HIV screening awareness was recommended.

Effect of aerobic and resistance exercise training on anthropometric parameters of human immunodeficiency virus-positive individuals

Background: The use of antiretroviral drugs has made human immunodeficiency virus (HIV)/AIDS a chronic disease with adverse anthropometric changes as one of its complications. Objectives: This study investigated the effects of aerobic and resistance exercise training on anthropometric parameters of HIV-positive individuals. The study examined the influence of aerobic and resistance exercises on body mass index (BMI), waist-to-hip ratio (WHR), percentage body fat and visceral fat of persons living with HIV/AIDS in a tertiary health institution in South–South zone of Nigeria. Methods: A randomised control trial design was employed in this study. Eighty-eight HIV-seropositive patients in stages 1 and 2 participated in the study. Randomisation was done into the control and aerobic exercise group and resistance exercise group. The experimental groups exercised thrice a week for 10 weeks and the non-experimental group received usual antiretroviral drugs and counselling. Initial intensity of the exercise was 60% HRmax and 1-RM and progression was by 10% every 3 weeks. Anthropometric parameters were recorded initially and on termination of 10 weeks for all three groups. Frequency, mean, standard deviation, and analysis of covariance (ANCOVA) were used for the data analysis. The Bonferroni pairwise comparison was used as post hoc test to identify the source of differences. Results: The outcome of this research showed that aerobic and resistance exercises resulted in significant alterations in anthropometric parameters of BMI (f = 13.617; Sig = 0.000), percentage body fat (f = 10.074; Sig = 0.000), WHR (f = 11.070; Sig = 0.000) and visceral fat (f = 10.286; Sig = 0.000). Conclusion: It was, therefore, concluded that aerobic and resistance are beneficial to HIV-seropositive persons and recommended that exercise should be prescribed for HIV-infected persons to enhance their anthropometric parameters resulting in improved health.

Seroprevalence and Molecular Detection of Symptomatic and Asymptomatic Genital Herpes Simplex Virus 2 among HIV Positive Patients: A Cross-sectional Study

Introduction: Genital Herpes Simplex Virus (HSV) infection is the most common infection in Acquired Immunodeficiency Syndrome (AIDS) patients, occurring in 60-90% according to World Health Organisation (WHO) reports. Early detection of HSV-2 infection, the introduction of chemotherapy, and prophylaxis improve the lifespan of AIDS patients. Aim: To detect the HSV-2 seroprevalence that is Immunoglobulin G (IgG) and Immunoglobulin M (IgM) antibodies in Human Immunodeficiency Virus (HIV) positive serum and molecular detection of HSV-2 Deoxyribonucleic Acid (DNA) in symptomatic HSV-2 Patients. Materials and Methods: The descriptive cross-sectional study was conducted in the Guntur Government Hospital with the help of the Antiretroviral Therapy (ART) Centre and Department of Dermatology, Venereology and Leprosy (DVL) in GGH, Guntur, Andhra Pradesh, India. A total of 100 blood samples from HIV positive individuals were collected and for those with symptoms on the external genitalia, a biopsy specimen from the ulcer and fluid from vesicles were taken. All the cases in the study group are on ART and without any antiviral treatment. A blood sample was collected for IgG (Calbiotech kit), IgM detection (Merilisa kit), and biopsy from genital ulcer for gene detection by realtime Polymerase Chain Reaction (PCR) (HELINI Biomolecules, Chennai). Statistical analysis was done by mean and percentages with p-value by calculating Chi-square test, Fisher’s-Exact test to know significance of association between HSV-2 and HIV. Results: Among the total 100 HIV positive patients, it was observed that IgG seroprevalence of HSV-2 in HIV positive individuals is 78%, while it is 19% for IgM. In the present study, 19 symptomatic cases showed DNA of HSV-2 in PCR, out of which, 17 were from genital ulcers and two from vesicle fluid. Conclusion: As HSV-2 is a lifelong infection, serological testing provides the best method, to estimate its prevalence even in asymptomatic individuals.

Plasma Levels of Secretory Calreticulin among HIV Infected Patients in Bauchi State

Objectives: Human immunodeficiency virus (HIV) is a lentivirus that causes HIV infection and over time acquired immunodeficiency syndrome. The objective was to evaluate plasma levels of Calreticulin (CALR) in HIV positive and negative individuals. Methods: A total of 164 participants were recruited and divided into four groups according to their viral load after estimation and individuals recruited as controls. Viral load was estimated in 1.1 ml of plasma according to manufacturers (COBAS Taqman HIV-1 Quantitative Test, v2.0, Roche Diagnostic GmbH, Germany). Plasma levels of CALR were analysed using ELISA (ELISA-Biotuva Life Sciences, UK). Results: Result revealed a significant difference (p = 0.00) between the CALR levels of individuals with low viral load and individuals with unsuppressed viral load, suppressed viral load, and controls. A significantly (p = 0.017) higher plasma CALR in individuals with unsuppressed viral load compared to those with suppressed viral load was found. No differences between plasma CALR levels of individuals with unsuppressed viral load and that of controls. Conclusion: Our study showed up regulation of plasma CALR in HIV-infected patients on long term antiretroviral therapy. We believe and from existing literature this up regulation is due partly if not solely to the oxidative stress and endoplasmic reticulum stress caused by the antiretroviral agents.

Statistical Methods of Handling Ordinal Longitudinal Responses with Intermittent Missing Data

The rate of survival of human immunodeficiency virus (HIV) positive individuals resume to ameliorate with the usage of highly active antiretroviral therapy (HAART), yet pulmonary disease prevalence is growing unstopped amongst some of them. Handling missing data was a difficult challenge in the health data concept. We compared the effect of marginal to the proposed ordinal negative binomial models in handling intermittent missing observations for better numerical performance. The data used was characterised by monotone missing observations due to patients’ failure to declare their pulmonary conditions (lung infections and complications) and other vital health information. The use of multiple imputations is one of the latest techniques for handling missing observations, and this technique is relevant to different missing data mechanism assumptions, but occasionally profiles with the complication of the kind of parameters to be imputed and the mechanism underlying the incomplete data. This study focuses on the importance and application of the methods of handling missing health data. The proposed ordinal negative binomial model performs greatly than other models in adjusting for monotone missing data without imputation. In a real application, the proposed ordinal negative binomial model produces low estimates as against direct likelihood, mixed effects proportional odd, and MI-GEE models.

Performance of the South African triage score among HIV positive individuals presenting to an emergency department

Over a quarter of patients presenting to South African Emergency Centres (EC) have concurrent human immunodeficiency virus (HIV), yet it is unclear how this impacts their presenting complaints, the severity of illness, and overall resource needs in the EC. The primary objective of this study was to compare the performance of the South African Triage Score (SATS) in people living with HIV (PLWH) compared to HIV-negative patients. Secondary objectives included comparing the presentation characteristics and resource utilisation of these populations. A prospective cross-sectional observational study was conducted in the Livingstone Hospital EC, Gqeberha, South Africa, to compare triage designation and clinical outcomes in PLWH and HIV-negative patients. In this six-week study, all eligible patients received point-of-care HIV testing and extensive data abstraction, including SATS designation and EC clinical course.Descriptive statistical analysis was completed, and a log-binomial model was used to examine the association between HIV status and clinical outcomes using crude (unadjPR) and adjusted prevalence ratios (adjPR). During the study period, 755 adult patients who consented to a POC HIV test were enrolled, of which 193 (25.6%) were HIV positive. HIV-positive patients were significantly more likely to be admitted compared to their HIV-negative counterparts when triaged as low acuity (adjPR 1.48, 95% CI 1.14-1.92, (p=0.003)). HIV-positive patients were also significantly more likely to receive laboratory testing when triaged as low acuity (adjPR 1.31, 95% CI 1.08-1.59 (p=0.006)) and as high acuity (adjPR 1.38, 95% CI 1.08-1.59 (p=0.034)) compared to HIV negative patients of the same triage categories. In our study, PLWH, compared to HIV-negative patients in the same category, were more likely to be admitted and require more EC resources, thus alluding to possible under triage of HIV-positive patients under the current SATS algorithm.

Current innovations in medical laboratory diagnosis of Tuberculosis

Tuberculosis (TB) is a major global health problem, ranking as the second highest cause of death from an infectious disease globally, after the human immunodeficiency virus (HIV). Nigeria ranked first in Africa with burden of TB. Tuberculosis is a major public health problem in Nigeria with about 407,000 people infected. The World Health Organization estimates that 120,000 people developed TB in 2019, with 154,000 death of whom, 13% were HIV positive individuals. Among the incident cases, 56% were from the South-East Asia and Western Pacific Regions and one quarter were from Africa. The African continent accounts for the highest rates of cases and deaths relative to population. Traditionally, tuberculosis is mostly being diagnosed by a combination of chest X-rays, the staining of sputum with special dyes followed by microscopy, the growth of Mycobacterium tuberculosis in culture and the Mantoux test. The sputum smear microscopy is easy to do and is very cheap and combined with chest X-rays has been used for a long time by TB control agencies worldwide. However, the sputum smear microscopy (sputum AFB) test has some problems in HIV-positive patients and children also in patients with low bacterial load and in latent TB infections. TB continues to be a complex disease to diagnose and manage due to the chronicity of the disease, the nature of the host-pathogen relationship, and the resulting diversity in its clinical manifestations. Therefore, this review considers recent innovations in TB laboratory diagnosis in conventional (traditional), non- conventional (molecular), serological (immunological) methods and the latest methods of TB diagnosis.

Effectiveness and safety of statins on outcomes in patients with HIV infection: a systematic review and meta-analysis

Statins are hypolipidaemic in human immunodeficiency virus (HIV) positive individuals. However, their effect on all-cause mortality and rate of discontinuation is unclear. We conducted a systematic review to evaluate the impact of statins on all-cause mortality, discontinuation rates, and risk of adverse effects among HIV patients on highly active antiretroviral therapy (HAART). We searched four electronic databases from inception until October 2021 for trials and cohort studies evaluating the effects of statin treatment versus placebo in HIV patients. Forty-seven studies involving 91,594 patients were included. Statins were associated with significantly lower risk of discontinuation (RR, 0.701; 95% CI 0.508–0.967; p = 0.031). The risk of all-cause mortality (RR, 0.994; 95% CI 0.561–1.588; p = 0.827), any adverse effects (RR, 0.780; 95% CI 0.564–1.077; p = 0.131) and, diabetes mellitus (RR, 0.272; 95% CI 0.031–2.393; p = 0.241) with statin treatment were lower but not statistically significant compared to placebo/control. Statin treatment was associated with a trend of higher but statistically insignificant risk of myalgia (RR, 1.341; 95% CI 0.770–2.333; p = 0.299), elevated creatine kinase (RR, 1.101; 95% CI 0.457–2.651; p = 0.830) and liver enzyme activities (RR, 1.709; 95% CI 0.605–4.831; p = 0.312). Clinicians should consider the nocebo effect in the effective management of PLWH on statins, who present with common adverse effects such as myalgia and, elevated levels of creatine kinase and liver enzymes.

Cryptococcal antigen prevalence in HIV patients from a tertiary care centre in South India.

Cryptococcosis is an opportunistic mycosis, caused by Cryptococcus neoformans. Cryptococcal meningitis is one of the most fatal opportunistic infections associated with human immunodeficiency virus (HIV) infection. The aim of this study was to find the prevalence of cryptococcal antigenemia in people living with HIV (PLHA) and also to find the prevalence of opportunistic infections among these patients. A total of 204 non duplicate samples were collected from people with HIV aged above 18 years. Samples with CD4 count less than 300 were included in the study. Cryptococcal antigen detection was done by CrAg Lateral flow assay. None of the patients in our study were positive for cryptococcal antigen. Opportunistic infections were observed in 82 (40.2%) HIV positive patients. Candidiasis, tuberculosis and Pneumocystis jiroveci pneumonia were the most common opportunistic infections. This is the first study from the southern state of Kerala on the prevalence of Cryptococcal antigenemia among HIV positive individuals. The study showed that routine screening for cryptococcal antigen will not be cost effective in our population. Similar to other studies, eventhough candidiasis, tuberculosis and PCP were more commonly seen among people with CD4 count < 200 cells/mm3, there was no statistically significant association.

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.

Comparative analysis of Candida spp. isolated from complete denture wearers with and without an HIV diagnosis

Statement of problemDenture-related stomatitis (DRS), an inflammation frequently present in human immunodeficiency virus-positive (HIV+) individuals, can be attributable to colonization by Candida spp., which is considered a main factor. The virulence factors of these species are often modulated by the systemic condition of their hosts. PurposeThe purpose of this clinical study was to evaluate the incidence, virulence, and morphology of Candida spp. isolated from biofilms of complete denture wearers with DRS, with and without an HIV diagnosis. In addition, the interaction of the systemic condition with the ability of Candida spp. to colonize was evaluated. Material and methodsFifty-five complete denture wearers diagnosed with DRS were divided into 2 groups: experimental (HIV+) and control (human immunodeficiency virus-noninfected participants [HIV-]). Biofilm was collected by a standardized method of ultrasonification of prostheses. The incidence was evaluated by a chromogenic method and polymerase chain reaction (PCR). The virulence factors were assessed by using the capacity for biofilm formation by counting colony-forming units (CFUs/mL), biofilm metabolism by tetrazolium salt metabolization, and proteinase and phospholipase production by using a fluorimetric kit. Morphology was verified by using the hyphae-inducing test, and participants’ health data were collected with a form. Data were analyzed by using the Student t, Mann-Whitney U, Spearman, and Fisher tests (α=.05). ResultsThe results of incidence were related to 55 participants (22 experimental and 33 control); in total, 63 Candida spp. samples were isolated, showing 28 Candida albicans and 36 nonalbicans strains. No significant difference was found between groups in baseline CFU/mL counts, biofilm formation capacity, cell metabolism, and phospholipase production. Proteinase production was higher for C. albicans in the control (P=.031) and for nonalbicans in the experimental (P=.016) groups. Relative to health data, the experimental group showed a moderate negative correlation between the CFU count/mL at baseline for nonalbicans and DRS classification (P=.020). ConclusionsC. albicans was the most prevalent species. No difference was found in the Candida spp. of complete denture wearers with DRS, with and without an HIV diagnosis, with regard to virulence factors (except for proteinase production) and morphology.

Molecular transmission network of pretreatment drug resistance among human immunodeficiency virus-positive individuals and the impact of virological failure on those who received antiretroviral therapy in China.

ObjectivesWe investigated the prevalence of pretreatment drug resistance (PDR), the molecular transmission network among HIV-positive individuals, and the impact of virological failure on those who received antiretroviral therapy (ART) in China.MethodsBased on the World Health Organization (WHO) surveillance guidelines for PDR, a baseline survey and follow-up were conducted in 2018 and 2021, respectively. Demographic information and plasma samples were obtained from all participants. HIV pol gene region sequences were used to analyze the PDR and molecular transmission networks using the Stanford HIV database algorithm and HIV-TRACE, respectively. This study assessed the odds ratios (OR) of PDR to virological failure (viral load ≥ 50 copies/mL) after 3 years of ART using multivariable logistic regression.ResultsOf the 4,084 individuals, 370 (9.1%) had PDR. The prevalence of PDR to non-nucleoside reverse transcriptase inhibitors (5.2%) was notably higher than that to nucleoside reverse transcriptase inhibitors (0.7%, p < 0.001), protease inhibitors (3.0%, p < 0.001), and multidrug resistance (0.3%, p < 0.001). A total of 1,339 (32.8%) individuals from 361 clusters were enrolled in the molecular transmission network. Of the 361 clusters, 22 included two or more individuals with PDR. The prevalence of virological failure among HIV-positive individuals after 3 years of ART without PDR, those with PDR to Chinese listed drugs, and those with PDR to other drugs was 7.9, 14.3, and 12.6%, respectively. Compared with that in HIV-positive individuals without PDR, virological failure after 3 years of ART was significantly higher (OR: 2.02, 95% confidence interval (CI): 1.25–3.27) and not significantly different (OR: 1.72, 95% CI: 0.87–3.43) in individuals with PDR to Chinese listed drugs and those with PDR to other drugs, respectively. Missed doses in the past month were significantly associated with virological failure (OR, 2.82; 95% CI: 4.08–5.89).ConclusionThe overall prevalence of PDR was close to a high level and had an impact on virological failure after 3 years of ART. Moreover, HIV drug-resistant strains were transmitted in the molecular transmission network. These results illustrate the importance of monitoring PDR and ensuring virological suppression through drug adherence.