Human Immunodeficiency Virus Positive Persons Research Articles

Prevalence of Mycobacterium Tuberculosis and Dermatophytes Co-Infection in Human Immunodeficiency Virus (HIV) Patients

The syndemic interaction between the Human Immuno Deficiency Virus (HIV) and opportunistic infections can have far reaching consequences on a person’s health. HIV associated dermatophytic infections result in extensive skin lesions which can be difficult to treatdue to poor response to conventional antifungal therapy. HIV- associated tuberculosis especially also contributed substantially to the burden of tuberculosis-associated morbidity and mortality. The Aim of this research was to study the co-infection of mycobacterium tuberculosis and dermatophytosis in a HIV positive population visiting the HIV clinics in some hospitals around Anyigba, Kogi State, Nigeria. Skin scrap samples were collected from nine hundred and seventy six (976) HIV positive persons within six (6) months for analysis. Out of these, 56 patients had dermatophytes infection, the skin leisons and skin scrap samples were further analyzed to identify the dermatophytes. Descriptive analysis, Student T tests and one way ANOVA were carried out to understand the various relationships. Most patient presented to the clinic with cough, fever, weight loss and multiple symptoms, and with CD4 values less than 200cells /ul and substantially between 200-349 cells/µl and 350-499cells/µl. The Predominant age of patients with HIV co-infected with tuberculosis and dermatophytosis was between 25-34 years and 35-44 years respectively. Dermatophytes were mostly found in patients with CD4 values which were equal or lower than 200 cells/µl irrespective of their age group. The predominant dermatophyte was Trichophyton species with Trichophyton tonsurans being the commonest species isolated followed by Trichophyton rubrum, Trichophyton mentagrophytes and Trichophyton gallinae. The finding of this study revealed that the prevalence of HIV infection led to higher progression rate of 10% active tuberculosis. It also revealed that Trichophyton species were the predominant dermatophytes in the environment with Trichophyton tonsurans being the most common isolate. Most patients visiting the hospital were already in the stage II and III of HIV infection in this area and the most common opportunistic infection is Tuberculosis.

Cause-Specific Mortality among HIV-Infected Persons in One Medical Center, Tehran, Iran

Background: Human immunodeficiency virus (HIV) is one of the major infectious agents, which has important role in the public health challenges, which have affected the world's economic and social situation recent decades. During the last decades, millions of people died due to HIV infection worldwide. However, data remain limited on the causes of death among HIV-infected in Iranian population. The aim of the present study was to assess the cause specific death among HIV positive inpatient persons in Iran.Materials and Methods: This surveillance was conducted on inpatient HIV positive admissions at Masih Daneshvari Hospital, Tehran, Iran during October 2016 and April 2017.All patient’s data were collected via abstraction form, which were ascertained, from medical records and from written logbooks that were kept by the nursing staff on the ward. The data of each admission was recorded from the medical reports at the time of admission and upon discharge. All laboratory data were collected and recorded separately.Results: Fifty persons were diagnosed as HIV-infected patients, of which 58% of them were classified as AIDS patients. Our findings indicated that the cause of hospitalization were pulmonary 54%, neurological 20%, gastrointestinal 16%, and dermal 10% complications. Overall, 21 patients (42%) were diagnosed with pulmonary tuberculosis, of which one patient died from tuberculosis complications. Four patients died during the study period.Conclusion: In conclusion, early treatment and/or early use of ART can be improved outcomes. Therefore, early HIV testing and early ART use play important role in mortality reduction among eligible persons.

Use of Non-Prescription Remedies by Ghanaian Human Immunodeficiency Virus-Positive Persons on Antiretroviral Therapy.

Inappropriate use of non-prescription remedies by persons living with human immunodeficiency virus (PLHIV) may result in adverse events or potentiate non-adherence to prescribed medications. This study investigated the use of non-prescription remedies among PLHIV receiving antiretroviral therapy (ART) from four treatment centers in southern Ghana. A mixed method design using quantitative and qualitative methods was used. This article focuses on the quantitative survey of 540 respondents. Univariate analysis was used to generate descriptive tabulations of key variables. Bivariate analysis and logistic regression modeling, respectively, produced unadjusted and adjusted associations between background attributes of PLHIV and the use of non-prescription remedies. A p-value of < 0.05 was considered statistically significant. All analyses were performed using IBM SPSS Statistics for Windows, Version 20.0. One out of three respondents reported the use of non-prescription remedies at least once within 3 months of the survey. Most of these were locally made and included "Angel natural bitters, concoctions from the Christian prayer centers, garlic, and mahogany syrups." These remedies were used concomitantly with antiretroviral medications (ARVs)-46% or administered with ARVs but at different times during the day (43%). Some of the remedies were reportedly prescribed by health workers, or self-initiated during periods of ARVs shortage. Others took them based on their perception of their efficacy. Bivariate level analysis identified ART clinic site, place of residence, and ARV adherence monitoring to be significantly associated with the use of non-prescription remedies (p < 0.05). Multiple logistic regression analysis controlling for covariates confirmed the location of ART clinic as the only predictor of the use of non-prescription remedies. Compared to clients at the large urban teaching hospital (Korle-Bu Fevers Unit ART center), those at the district level (Atua ART center) were ninefold more likely to use non-prescription remedies [adjusted odds ratio (AOR) = 8.84; 95% confidence interval (CI) 2.83-33.72]. Those from a district level mission hospital (St. Martin's ART center) were threefold as likely to use these remedies (AOR = 2.610; 95% CI 1.074-9.120). The use of non-prescription remedies by PLHIV on ART is common in southern Ghana. Usage is mostly self-initiated because of perceived efficacy of remedy, and was more common among clients attending rural ART clinics.

Disclosure status and disclosure intentions among HIV positive persons in rural western Kenya, 2011–2012

We examined associations between respondent characteristics and Human Immunodeficiency Virus (HIV) “disclosure status and intentions” of People Living with HIV (PLHIV) at next sexual encounter usin...

English

Cytomegalovirus (CMV) retinitis is an ocular manifestation of human immunodeficiency virus (HIV) infection especially in individual with low CD4 cells count. In Ghana, a country where CMV infection is hyperendemic, there is no data of CMV retinitis among HIV positive persons. This work was conducted to evaluate the prevalence of CMV retinitis among HIV positive persons attending eye clinic in Korle-Bu Teaching Hospital. Eye swab and vitreous samples were collected from HIV positive patients with retinal inflammation. The samples were assayed for DNA of Herpes Simplex Virus, Varicella Zoster, Cytomegalovirus and Epstein - Barr virus by using qualitative polymerase chain reaction (PCR) (multiplex PCR) to detect the presence or absence of herpes viruses. Sixty-two patients had retinal inflammation from ophthalmoscopy out of the total 404 that came into the clinic during the study period from July, 2010 to April, 2011. Forty six of these were HIV positive. Only 3 (6.5%) HIV positive patients had their swab or vitreous humour samples yielding DNA of CMV virus. These patients had their CD4 cell counts above 25 cells/&micro;l. This is the first study to show the prevalence of CMV retinitis among HIV patients in Korle-Bu Teaching Hospital, Ghana. It is necessary for more comprehensive longitudinal study to evaluate incidence and cumulative risk of CMV retinitis among HIV positive individual. Key words: Cytomegalovirus, human immunodeficiency virus, Ghana, Korle-Bu, retinitis, CD4, ophthalmoscopy.

Ocular complications in HIV positive patients on antiretroviral therapy in Ghana.

BackgroundPatients infected with human immunodeficiency virus (HIV) usually develop some form of ocular complication in the different segments of the eye due to immune deficiency. In Ghana, data regarding ocular complications among HIV/AIDS patients is scarce. This study investigated the occurrence of ocular complications in HIV infected patients undergoing antiretroviral therapy at the Agogo Presbyterian Hospital in the Ashanti Region of Ghana.MethodsBlood samples were taken from 100 confirmed HIV infected patients. The CD4 + T cell count and WHO clinical staging were determined. The patients were taken through thorough ophthalmic assessments to determine any ocular complications.ResultsForty-eight patients (48 %) had at least one HIV-related ocular complication. These complications occurred more frequently among those with CD4 counts below 200 cells/μL. Of the participants with HIV-related ocular complications, 11 (23 %) had retinal microvasculopathy, 10 (21 %) showed allergic conjunctivitis, 7 (15 %) had HIV retinopathy and 7 (15 %) had conjunctival carcinoma. All the participants in the study were on first-line antiretroviral therapy; 68 % were females and 72 % were in the Stage 3 of the WHO Clinical Staging of HIV infection.ConclusionThe prevalence of ocular complications in HIV positive persons under treatment in Ghana is high. Lower CD4 + T cell counts coupled with age were predisposing factors to HIV-related ocular complications.

The experiences of persons living with HIV who participate in mind-body and energy therapies: a systematic review protocol of qualitative evidence

The purpose of this systematic review is to explore the experiences and perceptions of persons living with HIV who participate in mind-body and energy therapies. The review will focus on the use of mind-body medicine and energy therapies that include meditation, prayer, mental healing, Tai Chi, yoga, art therapy, music therapy, dance therapy, Qigong, reiki, therapeutic touch, healing touch and electromagnetic therapy. These mind-body and energy therapies are selected categories because they do not involve options that might be contraindicated to an individual's current treatment regime. More specifically, the review questions are: Complementary and alternative medicine (CAM) is a popular adjunct to conventional medicine across global populations. Complementary generally refers to a non-mainstream approach together with conventional medicine whereas alternative refers to a non-mainstream approach in place of conventional medicine. Most people use non-mainstream approaches along with conventional treatments. The World Health Organization [WHO] defines CAM as distinct health-care practices that have not been assimilated into a country's mainstream health care system.The USA's National Center for Complementary and Integrative Health (NCCIH), formerly National Center for Complementary and Alternative Medicine (NCCAM), organizes CAM into five medical system categories: whole medical systems, mind-body medicine, biologically based practices, manipulative and body-based practices, and energy therapies. Whole medical systems include homeopathy, naturopathy, traditional Chinese medicine and Ayurveda. Mind-body medicine includes meditation, prayer, mental healing, Tai Chi, yoga, art therapy, music therapy and dance therapy. Biologically based practices include dietary supplements, herbal supplements and a few scientifically unproven therapies. Manipulative and body-based practices include massage and spinal manipulation such as chiropractic and osteopathic. Energy therapies include Qigong, reiki, therapeutic touch, healing touch and electromagnetic therapy.The NCCAM, the Alternative Medicine's Strategic Plan for 2011-2015 and the Healthy People 2020 envision a society in which all people have the opportunity to live long, healthy lives. In most countries, life expectancy has increased, but unfortunately, the incidence of chronic illnesses such as cardiovascular disease, cancer, hypertension, diabetes and depression continues to increase. Research findings indicate that the use of CAM is often greater among people living with a chronic or life threatening illness compared with the general population,Until the development of highly active antiretroviral medications (ARVs) in 1996, a diagnosis of human immunodeficiency virus (HIV) was considered to be a death sentence. The human immunodeficiency virus attacks the immune system and weakens a person's ability to combat infections and some types of cancer. Currently, there is no cure for HIV but because of lifesaving medications, the mortality rate has declined significantly. The disease is now considered a chronic illness and highly manageable. Effective treatment has resulted in approximately 35 million people worldwide still living with HIV at the end of 2012.Because HIV is no longer a death sentence but a chronic illness, there is a need to evaluate the experiences and perceptions of people using CAM, considering the prevalence of CAM use within this population. In the United States and Canada, the rate of CAM use among HIV positive persons is approximately 50% to 70%, whereas in Africa, rates of CAM use range from 36% to 68%. Popular forms of CAM among persons living with HIV include herbal or nutritional supplements, mind and body practices, and spiritual or religious healing. Worldwide, only a small percentage of persons who have access to ARVs refuse to take them and utilize CAM exclusively to treat their HIV infection.People living with HIV often report using CAM because they believe that these therapies will improve their overall health and well-being and provides them an opportunity to take some responsibility in managing their personal health, which includes medication side effects. However, the effect of CAM on an individual's physical health often cannot be measured physiologically, but may be felt or experienced.Understanding CAM use is essential so that health professionals will have the most accurate information about which integrative therapies may or may not be helpful for people living with HIV. As recommended by the Institute of Medicine report entitled, 'Integrative Medicine and Patient Centered Care', health professionals have a moral commitment to find innovative ways of obtaining evidence and expanding knowledge about diverse interpretations of health and healing. Research aimed at exploring patients' experiences and perceptions of mind-body and energy therapies is imperative so asto offer comprehensive care and promote shared decision making regarding complementary therapeutic options.

Zidovudine

Zidovudine

Prevalence and Predictors of Dyslipidemia on HAART and HAART Naive HIV Positive Persons in Defense Hospital, Addis Ababa, Ethiopia

Background: The introduction of highly active antiretroviral therapy (HAART) has led to a marked reduction in Acquired Immune Deficiency Syndrome (AIDS) related morbidity and mortality. However, HAART has been reported to be associated with a number of side effects in human immunodeficiency virus (HIV) positive persons among which dyslipidemia and lipodystrophy are common metabolic disorders. Objective: To assess the prevalence and predictors of dyslipidemia among HAART and HAART naive HIV positive persons in Defense Hospital, Addis Ababa-Ethiopia. Methods: A facility based comparative cross-sectional study among 228 HIV positive persons was conducted from September to October 2013. Socio-demographic and clinical data were collected using structured questionnaires. Fasting venous blood sample was drawn for laboratory analysis. Lipid profiles were measured using clinical chemistry analyzer (HumStar80, USA). CD4 cell counting was done using BD FACS Count™ (BD, USA). Anthropometric measurement was done. Data was analyzed using SPSS version 20 for windows. Result: A total of 228, 114 on HAART and 114 HAART naive HIV positive persons, were enrolled in the study. The overall prevalence of dyslipidemia was 63.6%. Prevalence of dyslipidemia in HAART naive and on HAART HIV positive persons was 61(53.5%) and 84(73.7%), respectively. The prevalence of TC≥200 mg/dl was 50% and 30%; HLD-c 25kg/m2 (AOR = 1.92, 95 % C.I: 1.20 - 4.81) were identified as determinants of dyslipidemia. Conclusion: The mean value of lipid profile was significantly higher on HAART as compared to HAART naive HIV positive persons. It is important to have well controlled cohort studies for the evaluation of long-term effects of HAART on lipid profiles.

Alexithymia is linked to neurocognitive, psychological, neuroendocrine, and immune dysfunction in persons living with HIV

The neuropathological changes resulting from Human Immunodeficiency Virus (HIV) infection may manifest in alexithymia (AL), a multidimensional trait characterized by impairments in the cognitive assimilation of feelings and emotions. A sample of 93 HIV survivors scoring high, i.e., ⩾74 on the 26-item Toronto Alexithymia Scale (TAS-26), were compared to 79 low AL (TAS-26⩽54) survivors on measures of neurocognitive, psychological, neuroendocrine and immune function. Neurocognitive function was evinced by a standardized test of psychomotor speed, cognitive flexibility and task switching ability, HIV Dementia and general cognitive status. Patients were also screened for levels of depression, anxiety and psychological stress. A 24-h urinary norepinephrine (NE) and cortisol (CORT) collection was taken; blood was drawn for T lymphocyte subset counts (CD4+CD3+) and HIV-1 viral load. Alexithymic patients exhibited higher levels of executive dysfunction, psychological distress, norepinephrine-to-cortisol (NE/CORT) ratio and viral load. Linear regression models accounting for sociodemographic and disease-related variables revealed two AL subscales, difficulties identifying and describing feelings, predicted and explained a significant proportion of variance in the outcome measures. Specifically, poorer executive task-switching/cognitive flexibility was associated with greater difficulty describing feelings; dysregulated autonomic response (high NE/CORT ratio) and depressive symptoms were predicted by difficulty identifying feelings; higher levels of anxiety and psychological stress were both predicted by greater difficulty describing and identifying feelings. Overall, the psychoneuroimmunological profile of alexithymia in HIV positive persons at mid-stage of infection suggests a greater vulnerability for disease progression.

Anemia and Risk Factors in HAART Naïve and HAART Experienced HIV Positive Persons in South West Ethiopia: A Comparative Study

BackgroundHuman immunodeficiency virus (HIV) infection and its treatment cause a range of hematological abnormalities. Anemia is one of the commonly observed hematologic manifestations in HIV positive persons and it has multifactorial origin.ObjectiveWe aimed to determine the prevalence and risk factors of anemia in highly active antiretroviral therapy (HAART) naïve and HAART experienced HIV positive persons.MethodsA facility-based comparative cross sectional study was conducted in Jimma University Specialized Hospital from February 1 to March 30, 2012. A total of 234 HIV positive persons, 117 HAART naïve and 117 HAART experienced, were enrolled in this study. Blood and stool specimens were collected from each participant. Blood specimens were examined for complete blood count, CD4 count and blood film for malaria hemoparasite; whereas stool specimens were checked for ova of intestinal parasites. Socio-demographic characteristics and clinical data of the participants were collected using pre-tested questionnaire. Statistical analysis of the data (Chi-square, student’s t-test, logistic regression) was done using SPSS V-16.ResultsThe overall prevalence of anemia was 23.1%. The prevalence of anemia in HAART naïve and HAART experienced persons was 29.9% and 16.2%, respectively (P = 0.014). Presence of opportunistic infections (P = 0.004, 95% CI = 1.69–15.46), CD4 count <200 cells/µl (P = 0.001, 95% CI = 2.57–36.89) and rural residence (P = 0.03, 95% CI = 1.12–10.39) were found to be predictors of anemia for HAART naïve participants. On the other hand, HAART regimen (ZDV/3TC/NVP) (P = 0.019, 95% CI = 0.01–1.24) and the duration of HAART (P = 0.007, 95% CI = 0.003–0.40.24) were found to be predictors of anemia for HAART experienced groups.ConclusionThe prevalence of anemia in HAART naïve persons was higher than HAART experienced persons. Risk factors for anemia in HAART naïve and HAART experienced HIV positive persons were different. Hence, there is a need for longitudinal study to further explore the causes of HIV associated anemia and the pattern of hemoglobin changes with initiation of HAART.

Stigma and underutilization of facility-based sexually transmitted infection services undermine human immunodeficiency virus testing in rural communities of Rivers State, Nigeria

Context: Human immunodeficiency virus (HIV) testing is a critical step in limiting the spread of the virus and ensuring access to prevention, treatment, care and support. Aims: The study examines the consequences of stigma and underutilization of facility-based sexually transmitted infection (STI) services on the uptake of HIV testing in rural communities of Rivers State, Nigeria, in other to provide information necessary to address the problem. Materials and Methods: A cross-sectional study was conducted between the 1 st and 30 th July 2011 among men and women of reproductive age living in rural communities of Rivers State, Nigeria, using a multistage sampling technique. Data were analyzed using the Epi-info version 6.04d, with confidence limit set at 95%. Results: A total of 596 participants: 270 men (45.3%) and 326 women (54.7%) were interviewed. Their mean age was 26.59 ± 7.77 years. Only 226 (37.9%) of them had ever tested for HIV. Most had stigmatizing attitudes towards HIV positive persons, 164 (71.6%) and had not tested for HIV (χ2 = 8.85, df = 1, P = 0.003). Of those who reported STIs, only 45.7% received treatment from a health facility, against 188 (54.3%) who did not. Consequently, only 90 (67.2%) of them were tested for HIV compared to 44 (32.8%) who received treatment from informal care providers (χ2 = 8.41, df = 1, P = 0.000). Conclusions: Stigma and low patronage of facility-based STI services undermine HIV testing. Anti-HIV campaigns must be consciously designed to prevent and correct stigmatization, emphasize the relationship between HIV and STIs and the significance of seeking appropriate care from health facilities.

Opportunistic And Other Intestinal Parasitic Infections In Aids Patients, Hiv Seropositive Healthy Carriers And Hiv Seronegative Individuals In Southwest Ethiopia

Human Immunodeficiency Virus (HIV) infection leads to acquired immunodeficiency syndrome (AIDS) and major causes of morbidity and mortality of such patients are opportunistic infections caused by viral, bacterial, fungal and parasitic pathogens. To determine the magnitude of opportunistic and non-opportunistic intestinal parasitic infections among AIDS patients and HIV positive carrier individuals. Cross-sectional study was conducted among AIDS patients, HIV positive healthy carriers and HIV negative individuals in Jimma University Hospital, Mother Theresa Missionary Charity Centre, Medan Acts Projects and Mekdim HIV positive persons and AIDS orphans' national association from January to May, 2004. Convenient sampling technique was employed to identify the study subjects and hence a total of 160 subjects were included. A pre-tested structured questionnaire was used to collect socio-demographic data of the patients. Stool samples were examined by direct saline, iodine wet mount, formol-ether sedimentation concentration, oocyst concentration and modified Ziehl-Neelsen staining technique. Out of 160 persons enrolled in this study 100 (62.5%) (i.e. 65 male and 35 female) were infected with one or more intestinal parasites. The highest rate 36 (69.2%) of intestinal parasites were observed among HIV/AIDS patients, followed by HIV positive healthy carriers 35 (61.4%) of and HIV negative individuals (29 (56.9%). Isospora belli 2 (3.9%), Cryptosporidum parvum 8 (15.4%), Strongyloides stercoralis 6 (11.5%) and Blastocystis 2 (3.9%) were found only in HIV/AIDS groups I. belli, C. parvum, S. stercoralis and Blastocystis are the major opportunistic intestinal parasites observed in HIV/AIDS patients. Therefore, early detection and treatment of these parasites are important to improve the quality of life of HIV/AIDS patients with diarrhoea.

Influence of socio-demographic factors on distances travelled to access HIV services: enhanced surveillance of HIV patients in north west England.

BackgroundPatient choice and access to health care is compromised by many barriers including travel distance. Individuals with the human immunodeficiency virus (HIV) can seek free specialist care in Britain, without a referral, providing flexible access to care services. Willingness to travel beyond local services for preferred care has funding and service implications. Data from an enhanced HIV surveillance system were used to explore geodemographic and clinical factors associated with accessing treatment services.MethodsWe extracted data on the location, type and frequency of care services utilized by HIV positive persons (n = 3983) accessing treatment in north west England between January 1st 2005 and June 30th 2006. Individuals were allocated a deprivation score and grouped by urban/rural residence, and distance to care services was calculated. Analysis identified independent predictors of distance travelled (general linear modelling) and, for those bypassing their nearest clinic, the probability of accessing a specialist service (logistic regression, SPSS ver 14). Inter-relationships between variables and distance travelled were visualised using detrended correspondence analysis (PC-ORD ver 4.1).ResultsHIV infected persons travelled an average of 4.8 km (95% confidence intervals (CI) 4.6–4.9) per trip and had on average 6 visits (95% CI 5.9–6.2) annually for care. Longer trips were made by males (4.8 km vs 4.5 km), white people (6.2 km), the young (>15 years, 6.8 km) and elderly (60+ years, 6.3 km), those on multiple therapy (5.3 km vs 4.0 km), and the more affluent living in rural areas (16.1 km, P < 0.05). Half the individuals bypassed their nearest clinic to visit a more distant facility, and this was associated with being aged under 20 years, multiple therapy, being a male infected by sex between men, relative wealth, and living in rural areas (P < 0.05). Of those bypassing local facilities, poorer people were more likely to access a specialist centre but did not have as far to travel to do so (3.6 km) compared to those from less deprived areas (8.6 km).ConclusionDistance travelled, and type of HIV services used, were associated with socioeconomic status, even after accounting for ethnicity, route of infection and age. Thus despite offering an 'equitable' service, travel costs may advantage those with higher income.

Overview of Cryptosporidium presentations at the 10th International Workshops on Opportunistic Protists.

It has been over 100 years since the discovery of Cryptosporidium in the stomachs of house mice by the prominent American microbiologist Ernest E. Tyzzer in 1907 (58) and over 30 years since the identification of Cryptosporidium as a human pathogen in 1976 (38, 40). Cryptosporidiosis remains an important opportunistic pathogen in human immunodeficiency virus-positive persons. This is due largely to the limited use of highly active antiretroviral therapy in developing countries and the lack of an effective drug against the parasite in immunocompromised persons. Recent research efforts in cryptosporidiosis are directed largely at characterizations of environmental ecology, infection source, and risk factors using molecular diagnostic tools, identifications of parasite-unique biochemical and metabolic pathways for drug development, and elucidations of immune responses and pathogenesis. These efforts have been greatly facilitated by the recent completion of whole-genome sequencing of Cryptosporidium parvum, Cryptosporidium hominis, and Cryptosporidium muris. The 26 research studies presented at the 10th International Workshop on Opportunistic Protists (IWOP-10) clearly reflected the current trends in cryptosporidiosis research.

A Replication-Limited Recombinant Mycobacterium bovis BCG Vaccine against Tuberculosis Designed for Human Immunodeficiency Virus-Positive Persons Is Safer and More Efficacious than BCG

Tuberculosis is the leading cause of death in AIDS patients, yet the current tuberculosis vaccine, Mycobacterium bovis bacillus Calmette-Guérin (BCG), is contraindicated for immunocompromised individuals, including human immunodeficiency virus-positive persons, because it can cause disseminated disease; moreover, its efficacy is suboptimal. To address these problems, we have engineered BCG mutants that grow normally in vitro in the presence of a supplement, are preloadable with supplement to allow limited growth in vivo, and express the highly immunoprotective Mycobacterium tuberculosis 30-kDa major secretory protein. The limited replication in vivo renders these vaccines safer than BCG in SCID mice yet is sufficient to induce potent cell-mediated and protective immunity in the outbred guinea pig model of pulmonary tuberculosis. In the case of one vaccine, rBCG(mbtB)30, protection was superior to that with BCG (0.3-log fewer CFU of M. tuberculosis in the lung [P < 0.04] and 0.6-log fewer CFU in the spleen [P = 0.001] in aerosol-challenged animals [means for three experiments]); hence, rBCG(mbtB)30 is the first live mycobacterial vaccine that is both more attenuated than BCG in the SCID mouse and more potent than BCG in the guinea pig. Our study demonstrates the feasibility of developing safer and more potent vaccines against tuberculosis. The novel approach of engineering a replication-limited vaccine expressing a recombinant immunoprotective antigen and preloading it with a required nutrient, such as iron, that is capable of being stored should be generally applicable to other live vaccine vectors targeting intracellular pathogens.

A study of reliability and validity of appraisal questionnaire (Chinese language version) of human immunodeficiency virus positive persons

To evaluate the Chinese language version of the appraisal questionnaire (AQ) for HIV/AIDS (HIV positive persons). The scale was translated and adapted into Chinese and then reversely translated into English. The internal consistency reliability, structural validity, differential validity and predictive validity were evaluated by prevalence study in the city of Guangzhou. Cronbach's alpha coefficient achieved a value ranged from 0.530 to 0.886, with satisfied predicted validity. The regression equation accounted for 24.4% of variance in anxiety, and all factors of cognition accounted for 11.4% of variance, among all factors, only factor one had significant influence on anxiety (t=3.838, P<0.001); the regression equation accounted for 38.6% of variance in depression, and all factors of cognition accounted for 26.0% of variance. Factor I and factor II had significant influence on depression (t=5.707, P<0.001; t = -2.876, P<0.01). The results of differential validity suggested the mean scores of factor III were lower in the group with lower education level and monthly salary. Meanwhile, the persons with monthly salary under 300 yuan RMB had higher mean score of factor I, and the persons with lower academic degree had lower mean score of factor II. The principal-components factor analysis yielded three factors with common factor larger than 1.0, which were threat, challenge and controllability; and the three factors accounted for 62.23% of the total variance. The AQ Chinese version attained satisfactory reliability and validity. Even considering some essential explanatory words for the Chinese version, the scale might be attempted to use in the population with HIV in our country.

HIV/Tuberculosis Co-Infection among Patients Attending a Referral Chest Clinic in Nasarawa State, Nigeria

Human immunodeficiency virus (HIV) and Mycobacterium tuberculosis (TB) co-infection rate was investigated among patients referred to a chest clinic in Nasarawa State Nigeria. Out of the 344 patients who presented with respiratory problems at the clinic 44.8% had TB infection 24.7% HIV infection and 12.8% HIV/tubercle bacilli co-infection. Co-infection rate in HIV infected persons (HIV) was 51.8% and 28.6% in those with TB infection. The relative risk of HIV positive persons being co-infected was 1.075 while it was 0.401 for TB infected persons. The estimated Odds Ratio (OR) shows that the risk of co-infection was 2.68 times higher among HIV persons than among those with TB. The attributable risk was 45% and shows the extent to which co-infection could be attributed to HIV infection. A key socio-economic variable eating in groups was significantly correlated with co-infection (r = 0.107; p < 0.05). The results of this study may provide a useful policy guide in the formulation of HIV and TB control measures in Nigeria. (authors)

Chronic Venous Insufficiency in HIV-Positive Persons with and without a History of Injection Drug Use

To examine chronic venous insufficiency in human immunodeficiency virus-positive persons with and without a history of injection drug use and to examine the extent to which neuropathy further increased the risk of chronic venous insufficiency. Cross-sectional stratified design with quota sampling. Infectious diseases clinic in a large, urban midwestern city. Human immunodeficiency virus-positive persons, 27 with no history of injection drug use and 46 with a history of injection drug use, who met the inclusion criteria, including being 30 to 65 years of age, not pregnant, and willing to respond to a questionnaire and have their lower legs examined, were enrolled until the quota for each stratum (no injection drug use and injection drug use) was filled. Chronic venous insufficiency clinical classification, injection drug use history, and presence of peripheral neuropathy. Sixty-one percent of injection drug users (28/46) presented with severe chronic venous insufficiency compared with 11% (3/27) of noninjection drug users (P< .001). The presence of lower extremity neuropathy was not significantly related to chronic venous insufficiency classification. This is the first study to report the high risk of chronic venous insufficiency in human immunodeficiency virus-infected persons who inject drugs. Chronic venous insufficiency should be assessed in human immunodeficiency virus-positive persons when there is a history of injection drug use, and measures to protect the legs should be implemented.

Characterization of CD8+T Cells and Microenvironment in Oral Lesions of Human Immunodeficiency Virus-Infected Persons with Oropharyngeal Candidiasis

Oropharyngeal candidiasis (OPC), the most common oral infection in human immunodeficiency virus-positive persons, correlates with reduced blood CD4+ T cells. In those with OPC, CD8+ T cells accumulate at the lamina propria-epithelium interface at a distance from the organism at the outer epithelium. The present study aimed to characterize the tissue-associated CD8+ T cells and tissue microenvironment in both OPC+ and OPC- persons. The results show that the majority of CD8+ T cells possess the alphabeta T-cell receptor, the thymus-derived alphabeta CD8 antigen heterodimer, and similar levels of the alpha(4)beta(7), alpha(4)beta(1), and alpha(e)beta(7) homing receptors. Studies to evaluate the tissue microenvironment showed that in OPC+ persons, the adhesion molecule for T cells to enter mucosa, mucosal addressin cell adhesion molecule, is significantly increased, whereas E-cadherin, which allows T cells to migrate through mucosa, is significantly decreased compared to OPC- persons. These results continue to support a role for CD8+ T cells against OPC under conditions of reduced numbers of CD4+T cells, with susceptibility to infection potentially associated with a dysfunction in mucosal CD8+ T-cell migration by reduced tissue-associated E-cadherin.