Human Immunodeficiency Virus Seropositive Individuals Research Articles

Prevalence of Malnutrition and Associated Factors among HIV Seropositive Adults on Antiretroviral Therapy at the Regional Hospital, Buea, Cameroon

Introduction: Malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients and HIV which infects CD4 cells causes immune suppression which can further be worsened by poor nutrition. More than 37.7 million people are living with HIV in the world out of which about 36 million are adults. Aims: The study aimed to determine the prevalence of malnutrition and associated factors among human immunodeficiency virus (HIV) seropositive adults on antiretroviral therapy at the HIV care and treatment center of the Buea Regional hospital, Cameroon. Study Design: A Hospital-based Cross sectional study design. Place and duration of study: Buea regional hospital at the HIV care and treatment centre, South West Region of Cameroon between April 2022 to June 2022. Materials and method: We included 139 HIV seropositive individuals (17 men, 177 women age range 26 to 59 years). Nutritional status was assessed using anthropometric and clinical methods. A 24-hour dietary diversity was assessed using a questionnaire. Data was analyzed using SPSS version 25.0. Results: The prevalence of underweight, overweight and obesity among the participants were 1.4 %, 38.8%, and 24.4% respectively. In the bivariate analysis, sex of the participants (χ2 = 4.715, p = 0.030) and attendance to HIV-related counseling sessions (χ2 = 4.512, p = 0.034) were significantly associated with malnutrition. The mean dietary diversity score of the study respondents was 4.97±1.6 with only 37% of the respondents achieving a minimum dietary diversity. In the multivariate logistic regression analysis, the odds of those who received HIV-related counselling being malnourished(overweight) was 3.29 times more than those who did not receive HIV-related counselling (AOR=3.29, p=0.036). Conclusions: There is a high burden of overweight and obesity in the HIV population of the Regional Hospital Buea. The only factor independently associated to malnutrition(overweight) was uptake of nutrition related counselling. Majority of the HIV seropositive patients in the Regional Hospital Buea had a poor dietary diversity. Nutritional counseling should be an important part of persons living with HIV/AIDS (PLWHA) routine follow-up.

Survival trends among people living with human immunodeficiency virus on antiretroviral treatment in two rural districts in Ghana.

The human immunodeficiency virus (HIV) has caused a lot of havoc since the early 1970s, affecting 37.6 million people worldwide. The 90-90-90 treatment policy was adopted in Ghana in 2015 with the overall aim to end new infections by 2030, and to improve the life expectancy of HIV seropositive individuals. With the scale-up of Highly Active Antiretroviral Therapy, the lifespan of People Living with HIV (PLWH) on antiretrovirals (ARVs) is expected to improve. In rural districts in Ghana, little is known about the survival probabilities of PLWH on ARVs. Hence, this study was conducted to estimate the survival trends of PLWH on ARVs. A retrospective evaluation of data gathered across ARV centres within Tatale and Zabzugu districts in Ghana from 2016 to 2020 among PLWH on ARVs. A total of 261 participants were recruited for the study. The data was analyzed using STATA software version 16.0. Lifetable analysis and Kaplan-Meier graph were used to assess the survival probabilities. "Stptime" per 1000 person-years and the competing risk regression were used to evaluate mortality rates and risk. The cumulative survival probability was 0.8847 (95% CI: 0.8334-0.9209). The overall mortality rate was 51.89 (95% CI: 36.89-72.97) per 1000 person-years. WHO stage III and IV [AHR: 4.25 (95%CI: 1.6-9.71) p = 0.001] as well as age group (50+ years) [AHR: 5.02 (95% CI: 1.78-14.13) p = 0.002] were associated with mortality. Survival probabilities were high among the population of PLWH in Tatale and Zabzugu with declining mortality rates. Clinicians should provide critical attention and care to patients at HIV WHO stages III and IV and intensify HIV screening at all entry points since early diagnosis is associated with high survival probabilities.

Prevalence and Viral Load Determination of Hepatitis B Virus among Hiv Seropositive Patients Attending Kogi State Specialist Hospital Lokoja, Kogi State

Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) share common risk factors and HBV occurs in people with HIV resulting in an increased risk for HIV/HBV co-infection. Globally, hepatitis B virus infection is of serious public health causing morbidity and mortality. The increasing incidence of liver diseases caused by HBV is emerging as a significant cause of morbidity and mortality among HIV-infected individuals. A clearer knowledge of HBV prevalence in Kogi State is important in order to educate, inform the population and control epidemics through extensive vaccination and treatment programme. The aim of this study was to determine the seroprevalence of Hepatitis B infection and to evaluate molecularly HBV infection among HIV seropositive individuals. Sera samples were obtained from 218 consented HIV participants and screened for HBsAg using the commercial membrane based rapid qualitative test kit and real-time PCR was performed using Tianlong to assay the virus quantitatively. A structured questionnaire was used to collect information on patient’s demographic variables and risk factors for HBV transmission. Overall, 17 of the participants were seropositive to HBsAg. There was a significant difference between the age distribution with (P-value = 0.006) and marital status with (P-value = 0.044). Type of marriage, occupation, place of residence and risk factors associated with HIV and HBV co-infection do not show significant differences. A total of 17 HBsAg positive samples were subjected to viral load analysis, out of which 7 were highly unsuppressed, 5 were suppressed while the remaining 5 were undetectable. This study confirmed a moderately high HIV/HBV co-infection rate (7.8%). The highly unsuppressed viral load obtained from the study is a potential risk for Hepatocellular carcinoma among the study population. Enlightenment programme on routes of virus acquisition with a view to reducing the morbidity and mortality of HIV/HBV co-infection should be intensified.

Diffuse Large B-cell Lymphoma in Adults at Chris Hani Baragwanath Academic Hospital

Background: Diffuse Large B-Cell Lymphoma (DLBCL) is the most common subtype of Non-Hodgkin lymphoma (NHL). DLBCL is a heterogenous disease and is the most common subtype of NHL occurring in Human Immunodeficiency Virus (HIV) seropositive individuals. Aim: The aim of the study was to review the clinical profile as well as the outcome of adult patients presenting with DLBCL, to a tertiary public sector hospital (Chris Hani Baragwanath Academic Hospital – CHBAH) in Soweto, Johannesburg, South Africa. Patients and Methods: The study entailed a retrospective review of 139 evaluable patients with DLBCL, over a 5 year period. Results: Of the 139 patients reviewed, there were 73 females (53%) and 66 males (47%), with a female: male ratio of 1.1:1. The median age of the patients was 41 years (14-85). Common presenting features included advanced stage disease (83%), constitutional or ‘B’ symptoms (74%), extra-nodal disease (73%) and lymphadenopathy (64%). 81% of the patients were HIV seropositive. The median overall survival was 24 months. Conclusion: DLBCL accounted for 35% of all the patients with NHL during the study period. HIV seropositivity, together with other factors such as significant delays in referral of the patients, late presentations with advanced stage disease, and comorbidities such as Tuberculosis, impacted negatively on the prognosis and the outcome of the patients with DLBCL. Despite the use of Combination Antiretroviral Therapy (cART), appropriate supportive care and specific modalities of treatment, DLBCL continues to pose a challenge in our clinical setting.

COMPARITIVE STUDY ON THE BACTERIAL QUALITIES IN TEARS BETWEEN HIV SEROPOSITIVE AND HIV SERONEGATIVE PERSONS IN BENIN CITY

HIV(Human immunodeficiency virus) is the etiological agent that produces the immunosuppression resulting in AIDS. The bacterial microbes from tears of HIV seropositive individuals were isolated and compared with those of HIV seropositive individuals. Tear samples were collected from 50 newly diagnosed subjects and from another 50 who were screened to be seronegative, all within the age range of 16-55 years (mean age 29 ± 0.78). Bacteriological analysis included isolation, characterization and enumeration of bacterial isolates found in tears. Microbial count was determined using the Miles and Misra serial dilution technique. Results were presented in tables and graphs and revealed the presence of Staphylococcus aureus and Pseudomonas auruginosa in all age groups irrespective of HIV status. Statistical analysis using the unpaired t-test revealed a statistical difference between the bacterial count in HIV seropositive and HIV seronegative subjects. P < 0.05.

Occurrence and clinical features of HIV and malaria in co-infected individuals in Osun State, Nigeria.

Human immunodeficiency virus (HIV) and malaria infections are among the major public health concerns in sub-Saharan Africa, where they are associated with high morbidity and mortality. The study was conducted to assess the occurrence and clinical features of HIV and malaria in co-infected individuals in Osun State, Nigeria. The study was cross-sectional, which involved 422 participants who were administered structured questionnaires for socio-demographic and clinical data. Venous blood was collected for malaria parasite detection and count from One hundred and seventy-four HIV seropositive individuals. They were re-examined clinically for HIV diagnosis, CD4 + T cell counts, and packed cell volume (PCV). The mean age of the participants was 28.48 ± 15.38 while the overall predominance of malaria among the HIV-positive patients was 11.5% (20/174). The malaria prevalence was significantly higher in female patients (P = 0.0088) and occupational status among students (P = 0.0001). Malaria/HIV co-infected patients had a significantly lower mean value of PCV (P = 0.0001), CD4 + cell count (0.0001), and temperature (0.0001) compared to HIV-infected patients having no malaria. The study showed that females had relatively higher malaria infection compared to their male counterparts. To achieve better management of HIV patients against malaria infection, proper preventive measures, antiretroviral therapy (ART), and chemoprophylaxis are a useful strategy to put in place. Also, the monitoring of CD4 + cell count, viral load, and some hematology indices on a regular basis is crucial.

HIV and Malaria co-infection and the impact of viral load and HAART usage on the development of Plasmodium falciparum Artemisinin and Lumefantrine resistant genes in Nnewi, Anambra State, Nigeria

Background: Human Immunodeficiency virus (HIV) and malaria co-infection poses a serious health threat in sub-Saharan Africa and other endemic countries. Highly active anti-retroviral therapy (HAART) is currently used to suppress viral loads. Methods: Blood samples collected from 400 participants comprising 200 HIV sero-positive and 200 sero-negative individuals was added to EDTA sample containers. Malaria parasitemia was evaluated using standard parasitological techniques followed by PCR techniques using the Quick Load One Taq One Step Polymerase Chain Reaction (PCR) for characterization of species of Plasmodium and resistant studies using specific primers. HIV viral load estimation was done using COBAS® TaqMan® Analyzer. Results: Malaria has prevalent rate of 22.75% in the study population, while the prevalence of malaria infection among the HIV sero-positive and sero-negative is 77.0% and 23% respectively. Socio-demographic factors had no significant association with the development of resistant genes. HAART exposed individuals had prevalence of PfK13 (6.9%) and Pfmdr-1 (20.8%). Viral load was significantly related with the development of resistant genes (100%) and (86.1%) for PfK13 and Pfmdr-1 respectively. Conclusion: Unsuppressed viral load in HIV sero-positive individuals heightens the prevalence of malaria parasitaemia and increases the chances of possible emergence and spread of PfK13 and Pfmdr-1 genes.

Use of ATP, GTP, ADP and AMP as an Index of Energy Utilization and Storage in HIV Infected Individuals at NAUTH, Nigeria: A Longitudinal, Prospective, Case-Controlled Study

Human immunodeficiency virus (HIV) is associated with altered metabolism and increased energy expenditure, this energy requirement increases significantly as the HIV disease progresses. This study aimed on the use of Adenosine triphosphate (ATP), Guanosine triphosphate (GTP), Adenosine diphosphate (ADP) and Adenosine monophosphate (AMP) as an index of energy utilization, storage and energy balance in HIV infected individuals. This is a longitudinal, prospective, case-controlled study involving seventy seven (77) HIV Sero-positive individuals newly diagnosed attending retroviral disease treatment centre of Nnamdi Azikiwe University University Teaching Hospital (NAUTH) aged 18-60 years both male and female not on highly active antiretroviral therapy (HAART), were enrolled in the study as test subjects and thirty six (36) apparently healthy HIV Sero-negative individuals both male and female as control subjects. ATP, GTP, ADP and AMP were estimated by enzyme linked immunosorbent assay (ELISA), while, total Energy Balance was determined by calculation. The data obtained were subjected to statistical analysis using SPSS software application (version 21.0) and the results expressed as mean ± standard deviation. The plasma ATP and GTP were significantly lower (P<0.05) in both HIV pre-treatment and post-treatment group compared with control group. Meanwhile, the plasma level of ADP and AMP were significantly lower (P<0.05) in HIV post-treatment group compared with HIV pre-treatment and control group. There was also a significant difference (P<0.05) in ATP, ADP, AMP and GTP level between HIV pre-treatment and post-treatment group. Meanwhile, the energy balance was lower (P<0.05) in HIV groups compared with control group. However, the energy balance in HIV post-treatment group was significantly lower (P<0.05) compared to HIV pre- treatment group. In conclusion, the significant changes in the biochemical parameters measured suggest altered metabolism, increased energy expenditure and energy deficit/negative energy balance in HIV subjects resulting from increased energy expenditure. Hence, High energy molecules such ATP, ADP, GTP and AMP can be used to predict early energy deficit and manage energy imbalance in HIV infected individuals.

Renal Doppler indices and their correlation with laboratory indices of human immunodeficiency virus sero-positive adult individuals

IntroductionRenal Doppler resistive index (RI) and pulsatility index (PI) values are potentially more sensitive at detecting renal abnormalities when compared to standard laboratory indices in patients with HIV/AIDS. To the best of our knowledge, there are no published research articles on renal Doppler indices and their correlation with laboratory indices of HIV sero-positive adult individuals. This study aimed to assess the renal function of HIV-sero-positive adults using RI and PI, and correlating these indices against laboratory values. MethodsA prospective cross-sectional study was conducted from July 2019 to April 2020. A purposive sampling method was employed and included 396 HIV sero-positive adult individuals. Sampling for the renal RI and PI was performed at the level of the inter-lober arteries, in between the medullary pyramids. An RI value above 0.70 and a PI value above 1.56 were consider abnormal. Serum creatine and urea together with evidence of proteinuria were recorded at the time of scanning. ResultsForty-three (10.9%) men had an abnormal RI, 32 (8.1%) had abnormal PI, five (2.5%) had abnormal creatinine, two (1%) abnormal urea and eight (4.1%) with proteinuria. In women, 29 (7.3%) had abnormal RI, 22 (5.6%) abnormal PI, four (2%) abnormal creatinine and urea and six (3%) had proteinuria. There was a statistically significant weak positive correlation between RI and PI and serum creatinine and urea (r > 0.2, P < 0.05). ConclusionThe proportion of patients with abnormal RI and PI was higher than the proportion of participants with abnormal serum urea, creatinine and proteinuria. Renal Doppler indices could be used be used in the early assessment of renal function in HIV sero-positive adults individuals. Implications for practiceSerum creatinine and urea are routinely used to evaluate renal function in patients with HIV/AIDS. Findings from this initial study show that RI and PI could be used detecting early renal abnormalities when compared to standard laboratory values.

Genotyping and Drug Susceptibility Patterns of M. Tuberculosis Isolated from HIV Seropositive Patients in Tehran Iran

to investigate the prevalence and drug-resistance M. tuberculosis isolated from HIV seropositive individuals in Tehran, Iran. Human immunodeficiency virus (HIV) is one of the most important risk factors for developing active tuberculosis (TB). To determine the rate of transmission and drug resistant M. tuberculosis (MTB) strains isolated from HIV seropositive patients in Tehran province, Iran. This study consecutively enrolled 217 TB/HIV coinfected patients from April 2018 to August 2019 at Emam Khomeini referral hospital and 5 other health centers in Tehran province. The isolates were genotyped using 15 loci Mycobacterial interspersed repetitive unit-variable number tandem repeats (MIRU-VNTR). Minimum inhibitory concentration (MIC) was determined for 6 drugs. In addition, mutations were assessed in rpoB, katG, inhA, and ahpC genes using Reverse Blot Hybridization Assay System. A 20 (9.2%) patients were culture-positive for M. tuberculosis and typed by MIRU-VNTR, 13 (65%) strains formed 5 clusters, but 6 (30%) isolates had a unique pattern. The total Hunter-Gaston discrimination index (HGDI) for all 15 loci was 0.846, and the cluster size was 2 to 4 patients. The estimated proportion of recent transmission was 45%. The mutation was identified in 1 isolate, lost inhAW1 and mutation in MT1 loci, which was resistant to isoniazid (INH). Moreover, 1 (5%) and 3 (15%) isolates were resistant to INH and ethambutol (EMB), respectively, of which 1 was resistant to INH and EMB. The transmission rate of TB in HIV patients was relatively high; however, the prevalence of drug-resistant strains and TB infection in females was insignificant in this study (p < 0.05); none of the isolates was MDR strains.

Depression and suicidal ideation among HIV seropositive patients attending the special treatment clinic of the University of Calabar Teaching Hospital, Calabar, Nigeria

Objectives: The introduction of highly active antiretroviral therapy and innovations in healthcare has contributed in improving the lives of persons living with human immunodeficiency virus (HIV)/AID. Patients infected with HIV are more susceptible to develop psychiatric illnesses. Depression is common among patients suffering from chronic illness such as HIV/AIDS and can exacerbate these illnesses. Depression has been observed to be twice as common in HIV seropositive individuals than in the general population. Undiagnosed and untreated depression in patients suffering from HIV/AIDS could lead to poor adherence to medications and lower quality of life. Depression is associated with rapid HIV disease progression. The diagnosis of HIV infection may be associated with feelings of anger, denial, sadness, guilt feelings, loss of self-esteem among others. These negative feelings could lead to suicidal ideation and attempted suicide or suicide. We sought to determine the prevalence rates, sociodemographics and predictors, of depression and suicidal ideation among study participants. Material and methods: Two hundred and two adult participants who met the inclusion criteria were recruited into the study. Mini International Neuropsychiatric Interview English version 6.0.0 was employed to diagnose depression and suicidal ideation. Data were analyzed using Statistical Package for the Social Sciences version 20.0. Significant levels were set at P &lt; 0.05. Results: This study revealed prevalence rates of 11.4% for depression and 7.9% for suicidal ideation among study participants. Majority of the participants were females in the young age group category of 30–40 years (45%) with mostly secondary education (47.8%), most had a higher CD4 count greater than 200 cells/µL (82.6%) and were mainly on zidovudine/lamivudine/nevirapine combination therapy (56.5%). Mean age, CD4 count, and viral load levels were lower in HIV patients with depression but were not statistically significant (P &gt; 0.05). CD4 count and viral load were not significantly associated with suicidal ideation. Lower age (30–40 years) was significantly associated with suicidal ideation (P &lt; 0.05). Suicidal ideation is a predictor of depression in the same way depression is a predictor of suicidal ideation (P &lt; 0.05). Conclusion: Routine screening for depression and suicidal ideation especially among younger HIV/AIDS patients is recommended in the clinic setting.

Prevalence and Associated Factors of TB Co-Morbidity Among HIV Sero-Positive Individuals in Shegaw Motta District Hospital, Ethiopia.

BackgroundTuberculosis (TB) is a major public health problem among people living with Human Immunodeficiency Virus (HIV) in resource-limited countries like Ethiopia. Up-to-date information regarding TB co-morbidity and determinant factors among HIV sero-positive individuals is lacking in the study area.ObjectiveThis study aimed to determine the prevalence of TB co-morbidity and their determinants among HIV sero-positive individuals in Shegaw Motta district hospital.MethodsA cross-sectional study was conducted among 326 people living with HIV from February to April 2019, in Shegaw Motta district hospital. The systematic random sampling technique was used to select the study participants. Data were entered into the EpiData version 3.1 and analysis was done using SPSS version 20.0.ResultsThe prevalence of TB/HIV co-infection was 18.1%. TB/HIV patients whose drunk alcohol (AOR=2.36, 95% CI=1.07–5.19), BMI< 16 (AOR= 19.13, 95% CI=4.14–88.36), and BMI ranges between 16 and 18.5 (AOR=9.78, 95% CI=3.07–31.19), World Health Organization (WHO) clinical stage IV (AOR=23.02, 95% CI=3.76–140.97), WHO clinical stage III (AOR=14.36, 95% CI=3.50–58.92), and WHO clinical stage II (AOR=4.17, 95% CI=1.34–13.01), bedridden (AOR=13.79, 95% CI=5.44–34.95) and ambulatory functional status (AOR=5.30, 95% CI=1.87–15.05) were significant predictors for TB/HIV co-infection.ConclusionThe prevalence of TB among HIV sero-positive individuals is high. Determinant factors, including drinking alcohol, BMI, WHO clinical stage and functional status, were significant predictors for TB/HIV co-infections. Therefore, diagnosis of TB among sero-positive individuals should be strengthened in health institutions.

Diagnostic oral biomarkers of immunosuppression in apparently healthy seropositive HIV population, in South Western Uganda

Background: Accurate diagnosis remain key to effective intervention of endemic and pandemic diseases even up to the developed world. Despite availability of many high-quality diagnostic tests for immunosuppression in the developed countries, they are neither available, affordable nor accessible in rural communities of Africa. Clinical diagnostic surrogate biomarkers may be suitable alternative. Objective: To evaluate oral clinical manifestations as biomarkers of immunosuppression in apparently healthy population of Human Immunodeficiency Virus (HIV) infected patients in resource poor Masaka, Mbarara and Rukungiri districts, of South Western Uganda. Methods: Visual oral inspection of 304 apparently health and HIV seropositive patients attending the AIDS Support Organization clinics in study districts of Uganda was done to detect and establish oral biomarkers associated with immunosuppression in HIV disease. Standard methods were used to reconfirm the HIV sero-positivity status and clinical staging of oral manifestations of consenting clients. Result: Figures 1-22 shows representative 304 oral manifestations of research participants. Figures 1-5 depicts 140 (46.1%) pseudomembranous candidiasis. Figures (6-9) depicts representative photographs of 53 (17.4%) erythemathous candidiasis (Figures 7 & 8) and also 63 (20.7%) shows erythemathous candidiasis found co-infecting with pseudomembranouse candidiasis in (Figures 9 & 10). Figure 10 shows linear gingival erythemathouse banding. Figures 11-15 shows Karposi sarcoma developmental stages and Figure 16-18 shows 7 (2.3%) Angular cheilitis. Figure 19 shows 3 (1.0%) aphthous ulceration of anterior portion of the tongue. Figure 20 shows 1 (0.3%) Acute necrotizing ulcerative gingivitis (ANUG) while Figures 21 & 22 shows 10 (3.3%) intra-oral pigmentation. Conclusion: Visual oral inspection of apparently healthy HIV seropositive individuals revealed different oral manifestations that may serve as diagnostic oral biomarkers of immunosuppression in apparently healthy but HIV infected population in Uganda. Poor resources drive the need for available and affordable diagnostic tools for improved and effective intervention.

Genetic Polymorphisms in the Open Reading Frame of the CCR5 gene From HIV-1 Seronegative and Seropositive Individuals From National Capital Regions of India

C-C chemokine receptor type 5 (CCR5) serves as a co-receptor for Human immunodeficiency virus (HIV), enabling the virus to enter human CD4 T cells and macrophages. In the absence of CCR5, HIV strains that require CCR5 (R5 or M-tropic HIV) fail to successfully initiate infection. Various natural mutations of the CCR5 gene have been reported to interfere with the HIV-CCR5 interaction, which influences the rate of AIDS progression. Genetic characterization of the CCR5 gene in individuals from the National Capital Regions (NCRs) of India revealed several natural point mutations in HIV seropositive/negative individuals. Furthermore, we identified novel frame-shifts mutations in the CCR5 gene in HIV seronegative individuals, as well as the well reported CCR5Δ32 mutation. Additionally, we observed a number of mutations present only in HIV seropositive individuals. This is the first report to describe the genetic variations of CCR5 in individuals from the NCRs of India and demonstrates the utility of investigating understudied populations to identify novel CCR5 polymorphisms.

Symptomatic Cryptococcal Antigenemia Presenting as Early Cryptococcal Meningitis With Negative Cerebral Spinal Fluid Analysis.

Individuals with cryptococcal antigenemia are at high risk of developing cryptococcal meningitis if untreated. The progression and timing from asymptomatic infection to cryptococcal meningitis is unclear. We describe a subpopulation of individuals with neurologic symptomatic cryptococcal antigenemia but negative cerebral spinal fluid (CSF) studies. We evaluated 1201 human immunodeficiency virus-seropositive individuals hospitalized with suspected meningitis in Kampala and Mbarara, Uganda. Baseline characteristics and clinical outcomes of participants with neurologic-symptomatic cryptococcal antigenemia and negative CSF cryptococcal antigen (CrAg) were compared to participants with confirmed CSF CrAg+ cryptococcal meningitis. Additional CSF testing included microscopy, fungal culture, bacterial culture, tuberculosis culture, multiplex FilmArray polymerase chain reaction (PCR; Biofire), and Xpert MTB/Rif. We found 56% (671/1201) of participants had confirmed CSF CrAg+ cryptococcal meningitis and 4% (54/1201) had neurologic symptomatic cryptococcal antigenemia with negative CSF CrAg. Of those with negative CSF CrAg, 9% (5/54) had Cryptococcus isolated on CSF culture (n = 3) or PCR (n = 2) and 11% (6/54) had confirmed tuberculous meningitis. CSF CrAg-negative patients had lower proportions with CSF pleocytosis (16% vs 26% with ≥5 white cells/μL) and CSF opening pressure >200 mmH2O (16% vs 71%) compared with CSF CrAg-positive patients. No cases of bacterial or viral meningitis were detected by CSF PCR or culture. In-hospital mortality was similar between symptomatic cryptococcal antigenemia (32%) and cryptococcal meningitis (31%; P = .91). Cryptococcal antigenemia with meningitis symptoms was the third most common meningitis etiology. We postulate this is early cryptococcal meningoencephalitis. Fluconazole monotherapy was suboptimal despite Cryptococcus-negative CSF. Further studies are warranted to understand the clinical course and optimal management of this distinct entity. NCT01802385.

First report of occult hepatitis B infection among ART naïve HIV seropositive individuals in Maputo, Mozambique.

BackgroundThe prevalence of hepatitis B virus (HBV) infection and human immunodeficiency virus (HIV) infection in Mozambique is one of the highest in the world, though in spite of this the prevalence of occult hepatitis B infection (OBI) is unknown.ObjectivesThis study was conducted with the aim to investigate the prevalence of OBI and frequency of isolated hepatitis B core antibody (anti-HBc alone) among antiretroviral (ART) naïve HIV-positive patients in Mozambique.MethodsA cross-sectional study was conducted in two health facilities within Maputo city. All ART-naive HIV seropositive patients attending outpatient clinics between June and October 2012 were consecutively enrolled. Blood samples were drawn from each participant and used for serological measurement of HBV surface antigen (HBsAg), antibodies against HBV surface antigen (anti-HBs) and antibodies against core antigen (anti-HBc) using ELISA. Quantification of HBV DNA was performed by real time PCR. A questionnaire was used to obtain demographics and clinical data.ResultsOf the 518 ART-naive HIV-positive subjects enrolled in the study, 90.9% (471/518) were HBsAg negative. Among HBsAg negative, 45.2% (213/471) had isolated anti-HBc antibodies, and the frequency of OBI among patients with anti-HBc alone was 8.3% (17/206). OBI was not correlated either with CD4+ T cells count or transaminases levels. A total of 11.8% of patients with OBI presented elevated HBV DNA level. Frequency of individuals with APRI score > 2 and FIB-4 score > 3.25 was higher in patients with OBI as compared not exposed, immune and anti-HBc alone patients.ConclusionOur data demonstrate for the first time that OBI is prevalent among HIV patients in Mozambique, and will be missed using the commonly available serological assays that measures HBsAg.

Clinico-mycological analysis and antifungal resistance pattern in human immunodeficiency virus-associated candidiasis: An Indian perspective.

Objectives:Candidiasis is a common human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome-associated opportunistic mycoses. The present study ascertained the species spectrum of Candida strains recovered from different clinical samples from symptomatic HIV-positive individuals and determined the antifungal susceptibility profile of the isolates.Materials and Methods:A variety of specimens were collected from 234 symptomatic HIV seropositive individuals depending on their clinical manifestations and subjected to direct microscopic examination. Blood samples were inoculated in biphasic blood culture medium and all other specimens on Sabouraud dextrose agar with chloramphenicol and incubated at 35°C–37°C. Species identification of the recovered Candida isolates was attempted on the basis of germ tube production, micromorphology on corn meal agar, color and morphology on HiCrome Candida Differential agar, and carbohydrate fermentation and assimilation tests. Susceptibility testing of the isolates was performed employing the VITEK 2 system.Results:A total of 167 Candida isolates were obtained; Candida albicans (136), Candida tropicalis (13), Candida krusei (8), Candida parapsilosis (5), Candida glabrata (4), and Candida kefyr (1). Fluconazole resistance was more frequent among nonalbicans species, and significantly higher 5-fluorocytosine resistance compared to C. albicans was also observed. Eight Candida strains (six C. krusei, one C. kefyr, and one C. albicans) were multidrug resistant.Conclusion:Although C. albicans continues to be the leading etiological agent of candidiasis, the incidence of nonalbicans species among HIV-positive Indian individuals is rising. Antifungal resistance was higher among nonalbicans Candida species. Another issue of therapeutic concern is the possible emergence of multidrug-resistant Candida strains among these patients.

Clinical features vary by the aetiology of meningitis in HIV seropositive patients: A four-year study from a tertiary hospital in India

Meningitis is a serious infection of the nervous system associated with high mortality in Human Immunodeficiency Virus (HIV) seropositive individuals. Asian clinical studies describing meningitis in people living with HIV are scarce. We describe the clinical features of meningitis in 116 HIV seropositive patients from a tertiary hospital in India as a cross-sectional observational study. The mean age of the patients in our study was 35±9 years with 70.6% of them being men. Eighty-five percent of the patients had an altered sensorium during the illness. Tuberculous meningitis [82.6%] was the most common cause. Clinical features varied by aetiology. Cranial nerve deficits [40%] were common in Cryptococcal meningitis. Hydrocephalus [3%], infarcts [15.9%] and IntraCranial Space Occupying Lesions (ICSOLs) [39.1%] were common in tuberculous meningitis.

Detection of Mycobacterium tuberculosis from the stool of HIV sero-positive individuals suspected of pulmonary tuberculosis.

BackgroundThe impact of tuberculosis (TB) is exacerbated in Africa because of the human immunodeficiency virus (HIV) pandemic. Pulmonary tuberculosis (PTB) diagnosis is difficult in HIV-infected patients and negative sputum results are more common which leads to diagnostic delay and increases morbidity and mortality. Extra-pulmonary samples such as stool may be easier to obtain and our approach may therefore significantly improve PTB detection in people living with HIV.ObjectiveTo detect Mycobacterium tuberculosis from the stool of HIV sero-positive individuals suspected of pulmonary TB.MethodA total of 117 HIV-infected individuals from three public health facilities in Addis Ababa, Ethiopia were enrolled consecutively in the study. Paired morning sputum and stool samples were simultaneously collected from anti-retroviral therapy (ART) naïve individuals living with HIV and suspected for PTB. The diagnostic accuracy of the smear microscopy, culture and region of difference (RD)9–based polymerase chain reaction (PCR) in stool was compared with the accuracy of sputum testing. Chi-square test and kappa value were used to compare different method used.ResultsSputum culture positivity for mycobacteria was confirmed in 33(28.2%) of the study subjects. Of 33 individuals positive for sputa culture, 10 individuals were observed to be stools culture positive. Of the 84 individuals negative for mycobacteria by sputum culture, three (3.6%) were stool culture positive and thus, the sensitivity and agreement between stool culture as compare to sputum culture were 30.3% and 0.33, respectively. Of 117 individuals, 11(9.4%) were sputum smear positive and of 11 sputum smear positive three were also stool smear positive. While of the 106 sputum smear negative individuals’, only one was stool smear positive resulting in 12.1% sensitivity and 0.18 agreements against sputum culture. On the other hand, the sensitivity of RD9-based PCR directly on stool was 69.7% by considering sputum culture as a reference standard. Moreover, RD9-based PCR directly on sputum detected 7(6.0%) individuals who were sputum culture negative for M. tuberculosis.ConclusionM. tuberculosis was detected in stool of individuals living with HIV who were negative for sputum smear microscopy and culture. Hence, examination of stool samples alongside with sputum samples increases the detection of PTB in individuals living with HIV.

A rare presentation of disseminated tuberculosis: Prostatic abscess

Involvement of the prostate by tuberculosis (TB) occurs rarely and tuberculosis prostate abscess is an even rarer occurrence. It has been reported in immunocompromised patients, mainly human immunodeficiency virus seropositive individuals. We are reporting a case of tuberculosis prostatic abscess in an immunocompetent patient with relapse of TB.