Human Immunodeficiency Virus Serologic Status Research Articles

Birth Control and Pregnancy Management Among Women Living with HIV

Objective: This study aimed to determine the birth control methods preferred by women living with human immunodeficiency virus (HIV) followed by our clinic and to review their pregnancy management strategies. Methods: The medical records of HIV-infected women followed by our clinic between 1999 and 2021 were analyzed retrospectively. The following parameters were recorded from medical files: Demographic characteristics, birth control methods used and the duration of usage, conception methods in those who became pregnant after being infected with HIV, whether the pregnancy was planned or not, the antiretroviral treatments used before pregnancy and whether treatment was modified during pregnancy, HIV-1 RNA and CD4+ T lymphocyte counts before delivery, type of delivery, prophylaxis given to the baby and the mother and its duration, and HIV serological status of the babies. Results: Out of 80 women actively followed by our clinic, 75 (93.7%) with available data were included in the study. The mean age of the cases was 43.5 +/- 11.4 (min=18-max=68). The number of cases using any birth control method was 51 (68%). The most common contraceptive method was a condom used by their partners (n=31, 60.7%). Thirty-six pregnancies developed in 25/60 (41.6%) sexually active cases not in the menopausal period and 33 babies were born. One baby was infected with HIV. Conclusion: Contraception methods in sexually active HIV-infected women should be chosen upon discussion between the healthcare provider and the patient. Close monitoring and standard care during pregnancy are critical for the long-term prognosis of both the mother and the baby.

Screening in the Birth Room of Parturients with Unknown Human Immunodeficiency Virus (HIV) Serological Status at the Reference Health Center of Commune IV of the District of Bamako

Introduction: In order to prevent the vertical transmission of the Human Immunodeficiency Virus (HIV), it is essential that pregnant women must know their HIV serological status. Objective: To determine the proportion of parturients with unknown Human Immunodeficiency Virus (HIV) status in the delivery room and to identify the associated factors. Methods: We conducted a prospective descriptive study carried out at the Reference Health Center of Commune IV in the district of Bamako from July 1, 2017 to July 1, 2018. The sample size was 267 parturients. The word processing was carried out on World software from the 2016 office suite at the end of the data entry and analysis was carried out on the IBM software, SPSS version 22.0. Results: A total of 267 women were eligible for our study, among which 14 parturients were seropositive, i.e., a proportion of 5.2% of cases. The knowledge of parturients on HIV was 95.5% of cases, but more than half did not know the mode of mother-child transmission. Unschooled parturients were the most represented with 41.2%. Conclusion: In view of the large proportion (5.2%) of HIV-positive parturients in our study, voluntary screening activities in the delivery room remain necessary for the future of children born to HIV-positive mothers.

Histoplasmosis Caused by Histoplasma capsulatum var. duboisii: A Comprehensive Review of Cases From 1993 to 2019.

Histoplasmosis caused by Histoplasma capsulatum var. duboisii (Hcd) is a rare, but probably underestimated, endemic infection described in intertropical Africa. Therefore, the epidemiology of the infection remains unclear, and there is no consensus on therapeutic management. Using a comprehensive search on different Internet databases, we collected case reports of Hcd infection published from 1993 to 2019. Epidemiological and clinical charts and therapeutic strategies were analyzed. We found 94 well-documented cases of Hcd infection, and 30.1% of the patients were under 18 years old. Symptoms occurred in some patients several decades after leaving the endemic area. Cutaneous/subcutaneous lesions, bone infections, and lymphadenopathies, both isolated and combined, were the most frequent presentations. The human immunodeficiency virus (HIV) coinfection rate was at 20.8%, with fever, lymphadenopathies, and an absence of bone infection being the differentiating elements from patients living without HIV. The rate of disseminated forms (60.6% in our review) significantly increased as compared to studies published before 1993, but without correlation with HIV infection. The global mortality rate was at 23.4% by the end of follow-up. The outcome was not correlated with the antifungal drug prescribed, nor with HIV serologic status, but was correlated with the initiation of an antifungal therapy. Hcd histoplasmosis is a severe fungal infection for which the precise mode of acquisition remains to be determined. There is a need for affordable and more specific diagnostic tools. Itraconazole and amphotericin B are the best therapeutic alternatives and should be available in all low-income countries of the endemic area.

HIV/AIDS and Syphilis Sero-prevalence Among Pregnant Women Attending Antenatal Care Center in Rwanda

Sexually transmitted infections pause a global challenge. Mostly, human immunodeficiency virus (HIV) and syphilis which are both transmitted sexually, infect a substantial number of people where female are at front line of exposure and high risk. Additionally, pregnant women experience more vulnerability exposing their infants to increased risk of dying from prematurity, low-birth-weight, stillbirth and congenital diseases. Therefore, continued surveillance of this co-infection is of paramount to establish the status of the diseases and increase the awareness. The current study has evaluated sero-prevalence of HIV and syphilis among pregnant women attending antenatal care center in Rwanda. In total, 1672 pregnant women who visited antenatal care center from 1st/sup> January to 31st/sup> December 2017 were included in the study. First, retrospectively, 1320 patient’s files were reviewed and all HIV and syphilis serological status and demographic characteristics were recorded from 1st/sup> January 2017 to 30th September 2017. Second, prospectively, from 1st/sup> October to 31st/sup> December 2017, 352 participants who accepted to participate in the study, gave blood sample for HIV and syphilis testing. The data were entered in SPSS version 22 and frequencies, percentage and chi-square tests were performed. As results, HIV and syphilis sero-prevalence were 71 (4.2%) and 29 (1.7%) respectively. In addition, 20 (1.2%) had HIV/syphilis co-infection. The cohabitant women exhibited higher HIV/syphilis co- infection than other women. HIV/syphilis co-infection exhibited a statistical significant association P.value 0.000. This finding suggest continued surveillance and special intervention for pregnant women to reduce their increased risk of sexually transmitted infection. In addition, cohabitant women need special intervention to reduce their increased risk of infection.

Analysis of Programmed Death Ligand 1 (PD-L1) Expression in Diffuse Large B Cell Lymphomas (DLBCL) in HIV-Negative Versus HIV-Positive Patients

Introduction: Through its interaction with PD-L1, the inhibitory receptor programmed death 1 (PD-1) is a key immune "checkpoint" that regulates adaptive immunity in both infectious and neoplastic diseases. Co-opted expression of PD-L1 by cancers can thus inhibit endogenous T cell anti-tumor responses, thereby permitting escape from immune destruction, yet offering a novel means of immunotherapy by antibody blockade of the PD-1/PD-L1 axis. Elevated expression of PD-L1 within melanomas and numerous carcinomas has been associated with adverse prognosis. We previously described the expression of PD-L1 in a subset of DLBCL cases, particularly in those of non-GCB phenotype (Andorsky et al, Clin. Cancer Res. 2011). Human immunodeficiency virus (HIV)-related DLBCLs are a subgroup of DLBCLs with have a more aggressive clinical course, even in the era of combination antiretroviral therapy. HIV-related DLBCLs are often associated with severe immunosuppression, however, the expression of PD-L1 in HIV-related DLBCL is unknown. In this study, we examined the relationship between PD-L1 expression, HIV status, and clinical outcomes.Methods: A total of 135 cases of incident DLBCL diagnosed between 2000-2007 were included from patients at Kaiser Permanente California, an integrated health care system. Of these, 57 were HIV-pos DLBCL patients, and 78 HIV-neg DLBCL patients were selected age, sex and race matched to the HIV-pos cases. Patients were characterized according to International Prognostic Index (IPI) risk factors, and cell-of-origin (COO; germinal center B [GCB] versus non-GCB) using the Hans classifier. PD-L1 staining was performed by immunohistochemistry, with dual staining for the PAX5 B cell marker used to distinguish tumor cell versus non-tumor /stromal macrophage expression of PD-L1. A 10% cutoff point was used to classify cases as positive for PD-L1 expression by tumor cells. Mortality within 2 years of DLBCL diagnosis and cause of death were ascertained. The association between PD-L1 expression and HIV status was evaluated using the t-test. The association between PD-L1 expression and patient survival was examined using multivariable Cox model, adjusting for IPI, COO and HIV status.Results: Tumor cell expression of PD-L1 was noted in 7.7% of HIV-neg cases versus 17.5% of HIV-pos cases (p=0.08). Expression of PD-L1 within the non-tumor stromal macrophages was more common, seen in 70.5% of HIV-neg and 68.4% of HIV-pos cases (p=0.79) using a 10% cutoff for stromal cell expression. Using a 30% cutoff for stromal cell expression, fewer cases were PD-L1 positive, but the frequency did not differ significantly between the HIV-neg and HIV-pos cohorts (32.1% and 31.6%, respectively, p=0.95). Clinical outcome, measured by 2 year lymphoma-specific mortality (LSM), was negatively affected by HIV serologic status, being 11.5% in HIV-neg versus 28.1% in HIV-pos cases (p=0.01). With regards to tumor cell PD-L1 expression, among HIV-neg cases, both all-cause mortality (ACM) and LSM did not appear to correlate with PD-L1 status (p=0.67 and p= 0.51, respectively). However, among HIV-pos subjects, tumor cell PD-L1 expression was associated with adverse ACM (p=0.05, HR 3.08 [1.03-9.28]) and LSM (p=0.03, HR 4.01 [1.11-8.48]) when adjusted for IPI and COO. In an additional overall analysis combining all 135 HIV-neg and HIV-pos cases, tumor cell PD-L1 expression was again correlated with worse outcome in terms of ACM (p=0.04, HR 2.38 [1.02-5.56]), and LSM (p=0.03, HR 3.07 [1.11-8.48]). In contrast, stromal cell PD-L1 expression did not correlate with outcomes in any of these analyses.Conclusions: Expression of the negative T cell regulatory protein PD-L1 on tumor cells was found on a minority of cases of DLBCL, though at least numerically more often in HIV-pos cases than in HIV-neg in this relatively small series. Association between tumor cell PD-L1 expression and adverse outcome was seen in HIV-pos but not HIV-neg subjects. Expression of PD-L1 within tumors in HIV-infected subjects could possibly render these tumors more amenable to immune escape than in HIV-pos subjects, or be a marker for more aggressive intrinsic biology of these tumors. Lastly, since immunotherapy with PD-1 blockade has recently been shown to have efficacy against some B cell lymphomas (Lesokhin et al, ASH 2014), this form of immunotherapy could possibly improve the less favorable outcomes of patients whose tumor cells express PD-L1. DisclosuresTimmerman:Valor Biotherapeutics: Research Funding; Janssen: Research Funding; Bristol-Myers Squibb: Honoraria, Research Funding.

Presentation, Treatment, and Clinical Outcomes of Patients With Hepatocellular Carcinoma, With and Without Human Immunodeficiency Virus Infection

Liver-related complications such as hepatocellular carcinoma (HCC) are a major cause of morbidity and mortality in individuals infected with human immunodeficiency virus (HIV), particularly among those also infected with hepatitis B or hepatitis C viruses. There is a lack of consensus regarding the clinical presentation, treatment options, and outcomes in HIV-infected patients with HCC. We compared the clinical presentation, treatment, and survival of patients with HCC, with and without HIV infection. We conducted a retrospective cohort study of cirrhotic patients diagnosed with HCC at a large safety-net hospital between January 2005 and December 2010. Patients without known HIV serologic status were excluded. Demographic features, tumor characteristics, treatment regimens, and survival were compared between patients (n = 26) with and without HIV infection (n = 164). Survival curves were generated by using Kaplan-Meier plots and compared by using the log-rank test. A higher percentage of HIV-infected patients presented with compensated liver disease (Child-Turcotte-Pugh stage A) than those without HIV infection (62% vs 32%, respectively; P = .01), as well as those with early-stage tumors (Barcelona Clinic Liver Cancer stage A, 39% vs 17%, respectively; P = .04 and Okuda stage I, 50% vs 21%, respectively; P < .01). HIV-infected patients were more likely to be cured of HCC than uninfected patients (27% vs 4%, respectively; P = .01), but median overall survival times were similar between groups (9.6 vs 5.2 months, respectively; P = .85). The 1-year rates of survival for HIV-infected and uninfected patients were 40% and 38%, respectively. HIV-infected patients present with earlier-stage HCC and more preserved liver function than uninfected patients, resulting in more curative treatment options. Despite this difference, overall survival was similar between patients with HCC with and without HIV infection.

Surveillance of Occupational Blood and Body Fluid Exposures Among French Healthcare Workers in 2004

To estimate the incidence rate of reported occupational blood and body fluid exposures among French healthcare workers (HCWs). Prospective national follow-up of HCWs from January 1 to December 31, 2004. University hospitals, hospitals, clinics, local medical centers, and specialized psychiatric centers were included in the study on a voluntary basis. At participating medical centers, every reported blood and body fluid exposure was documented by the occupational practitioner in charge of the exposed HCW by use of an anonymous, standardized questionnaire. A total of 375 medical centers (15% of French medical centers, accounting for 29% of hospital beds) reported 13,041 blood and body fluid exposures; of these, 9,396 (72.0%) were needlestick injuries. Blood and body fluid exposures were avoidable in 39.1% of cases (5,091 of 13,020), and 52.2% of percutaneous injuries (4,986 of 9,552) were avoidable (5.9% due to needle recapping). Of 10,656 percutaneous injuries, 22.6% occurred during an injection, 17.9% during blood sampling, and 16.6% during surgery. Of 2,065 splashes, 22.6% occurred during nursing activities, 19.1% during surgery, 14.1% during placement or removal of an intravenous line, and 12.0% during manipulation of a tracheotomy tube. The incidence rates of exposures were 8.9 per 100 hospital beds (95% confidence interval [CI], 8.7-9.0 exposures), 2.2 per 100 full-time-equivalent physicians (95% CI, 2.4-2.6 exposures), and 7.0 per 100 full-time-equivalent nurses (95% CI, 6.8-7.2 exposures). Human immunodeficiency virus serological status was unknown for 2,789 (21.4%) of 13,041 patients who were the source of the blood and body fluid exposures. National surveillance networks for blood and body fluid exposures help to better document their characteristics and risk factors and can enhance prevention at participating medical centers.

HCV and HIV infection and co-infection: injecting drug use and sexual behavior, AjUDE-Brasil I Project

This study aimed to characterize sexual and drug-use behaviors in injecting drug users (IDUs) in relation to single hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection and HCV/HIV co-infection. The sample consisted of 272 IDUs enrolled in the AjUDE-Brasil I Project, a cross-sectional multi-center study conducted in five Brazilian cities in 1998. Data were collected with a structured questionnaire using self-reported risk behavior, and HCV and HIV serological status used ELISA on filter paper. IDUs were clustered in four distinct groups: HCV/HIV seronegative; HCV mono-infected; HIV mono-infected; and HCV/HIV co-infected. Active sharing of injecting equipment was associated with HCV infection (p = 0.001). Sexual behavior variables, especially male same-sex sexual relations, were consistently associated with HIV infection. HCV/HIV co-infection was associated with both sexual and drug use variables. It was possible to distinguish different behavioral indicators for HCV and HIV infection and co-infection in this population.

Clinical characteristics and initial management of patients with tuberculous pericarditis in the HIV era: the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registry

BackgroundThe incidence of tuberculous pericarditis has increased in Africa as a result of the human immunodeficiency virus (HIV) epidemic. However, the effect of HIV co-infection on clinical features and prognosis in tuberculous pericarditis is not well characterised. We have used baseline data of the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registry to assess the impact of HIV co-infection on clinical presentation, diagnostic evaluation, and treatment of patients with suspected tuberculous pericarditis in sub-Saharan Africa.MethodsConsecutive adult patients in 15 hospitals in three countries in sub-Saharan Africa were recruited on commencement of treatment for tuberculous pericarditis, following informed consent. We recorded demographic, clinical, diagnostic and therapeutic information at baseline, and have used the chi-square test and analysis of variance to assess probabilities of significant differences (in these variables) between groups defined by HIV status.ResultsA total of 185 patients were enrolled from 01 March 2004 to 31 October 2004, 147 (79.5%) of whom had effusive, 28 (15.1%) effusive-constrictive, and 10 (5.4%) constrictive or acute dry pericarditis. Seventy-four (40%) had clinical features of HIV infection. Patients with clinical HIV disease were more likely to present with dyspnoea (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.4 to 7.4, P = 0.005) and electrocardiographic features of myopericarditis (OR 2.8, 95% CI 1.1 to 6.9, P = 0.03). In addition to electrocardiographic features of myopericarditis, a positive HIV serological status was associated with greater cardiomegaly (OR 3.89, 95% CI 1.34 to 11.32, P = 0.01) and haemodynamic instability (OR 9.68, 95% CI 2.09 to 44.80, P = 0.0008). However, stage of pericardial disease at diagnosis and use of diagnostic tests were not related to clinical HIV status. Similar results were obtained for serological HIV status. Most patients were treated on clinical grounds, with microbiological evidence of tuberculosis obtained in only 13 (7.0%) patients. Adjunctive corticosteroids were used in 109 (58.9%) patients, with patients having clinical HIV disease less likely to be put on them (OR 0.37, 95% CI 0.20 to 0.68). Seven patients were on antiretroviral drugs.ConclusionPatients with suspected tuberculous pericarditis and HIV infection in Africa have greater evidence of myopericarditis, dyspnoea, and haemodynamic instability. These findings, if confirmed in other studies, may suggest more intensive management of the cardiac disease is warranted in patients with HIV-associated pericardial disease.

A simple semi-rapid HIV-1&2 confirmatory immunoassay using magnetic particles

The Bionor™ HIV-1&2 Confirmatory Test is a semi-rapid simple immunoassay based on magnetic particles for the confirmation of serological status to human immunodeficiency virus (HIV). The specificity and sensitivity of this assay was evaluated by comparison with the Diagnostic Biotechnology HIV-1 Western blot (WB) 2.2 and the HIV-2/SBL-6669 WB. Bionor’s confirmatory test demonstrated 98% specificity when testing sero-negative blood donors and false positive sera in screening tests compared to 81.5 and 71.6%, respectively, using the HIV-1 WB. The sensitivity of this assay for HIV-1 antibody positive sera was 97.9% compared to the WB which was 99.5%. When testing confirmed HIV-2 antibody positive samples, 2/100 scored negative using this confirmatory test similar to other HIV-2 peptide-based line immunoassays available commercially, whilst 8/100 were indeterminate reacting to HIV-2 membrane antigens only. Bionor’s confirmatory test detected HIV-1 seropositivity earlier than the WB in longitudinal seroconversion panels and could discriminate between HIV-1 and -2 infection. The number of indeterminate responses was generally reduced significantly using Bionor’s confirmatory test compared to the HIV-1 WB. The greater specificity, speed and ease of interpretation of Bionor’s confirmatory test renders it an attractive and cost effective alternative to the WB for confirming HIV serological status worldwide.

New rapid diagnostic tests for HIV infection

Technological advances in the diagnosis of human immunodeficiency virus (HIV) infection provide the clinician with greater opportunities to reduce HIV transmission rates. The main drawback of conventional methods of HIV testing is a potential delay of 1–2 weeks for obtaining results, making routine screening a two-step method. Many of those tested never return to learn of their results, limiting our efforts to notify seropositive individuals and their contacts. Consequently, our ability to educate them on strategies for optimizing their health and reducing their risk for transmitting the disease is impaired. For pregnant women who present to Labor and Delivery with late prenatal care, having unknown HIV serological status reduces our ability to prevent transmission to neonates. Two new rapid HIV tests have become available commercially. These tests are just as accurate as conventional methods and offer the advantage of producing preliminary results within hours rather than days. As a result, case- finding and prevention counseling can be completed in a single visit, making the process more efficient and, hopefully, more effective. Additionally, faster identification of seropositive pregnant women who present later for prenatal care allows us to more precisely target intrapartum antiretroviral therapy for prevention of vertical HIV transmission.

The genes encoding the gCIII complex of human cytomegalovirus exist in highly diverse combinations in clinical isolates.

The UL74 (glycoprotein O [gO])-UL75 (gH)-UL115 (gL) complex of human cytomegalovirus (CMV), known as the gCIII complex, is likely to play an important role in the life cycle of the virus. The gH and gL proteins have been associated with biological activities, such as the induction of virus-neutralizing antibody, cell-virus fusion, and cell-to-cell spread of the virus. The sequences of the two gH gene variants, readily recognizable by restriction endonuclease polymorphism, are well conserved among clinical isolates, but nothing is known about the sequence variability of the gL and gO genes. Sequencing of the full-length gL and gO genes was performed with 22 to 39 clinical isolates, as well as with laboratory strains AD169, Towne, and Toledo, to determine phylogenetically based variants of the genes. The sequence information provided the basis for identifying gL and gO variants by restriction endonuclease polymorphism. The predicted gL amino acid sequences varied less than 2% among the isolates, but the variability of gO among the isolates approached 45%. The variants of the genes coding for gCIII in laboratory strains Towne, AD169, and Toledo were different from those in most clinical isolates. When clinical isolates from different patient populations with various degrees of symptomatic CMV disease were surveyed, the gO1 variant occurred almost exclusively with the gH1 variant. The gL2 variant occurred with a significantly lower frequency in the gH1 variant group. There were no configurations of the gCIII complex that were specifically associated with symptomatic CMV disease or human immunodeficiency virus serologic status. The potential for the gCIII complex to exist in diverse genetic combinations in clinical isolates points to a new aspect that must be considered in studies of the significance of CMV strain variability.

A large, simple trial of a tuberculosis vaccine.

Although there are no new tuberculosis vaccines currently available, it is possible to estimate the infrastructure needed for efficacy trials of such a vaccine. A randomized, placebo-controlled vaccine strategy for community-wide vaccination of adults is proposed: a large, simple trial with recipients stratified at enrollment by human immunodeficiency virus serologic status and purified protein derivative-skin test status. The outcome, tuberculous disease, would be assessed by community-wide surveillance. Such a trial could be carried out in populations in developed countries where the annual incidence of tuberculous disease is >100 cases per 100,000 persons and in developing countries where the incidence is >400 per 100,000 persons. In developed countries, enrollment of 14,600-80,000 persons would be needed, depending on the initial assumptions; in developing countries, enrollment would be 4400-27,000 persons. Readiness for tuberculosis vaccine efficacy trials will require epidemiological field studies to identify potential trial sites and investment in local diagnostic, surveillance, and data management capabilities.

Immunohistochemical Detection of Bcl-2 in Kaposi's Sarcoma Lesions Varies According to Histopathologic Stage, Whereas Expression of Bcl-x and Mcl-1 Differs According to Human Immunodeficiency Virus Serologic Status of Patients

Expression of Bcl-2, Bcl-x, and Mcl-1 was immunohistochemically evaluated in 33 cases of Kaposi's sarcoma (KS) of the skin. Of these, classic KS (C-KS) accounted for 17 cases (10 in plaque stage and 7 in tumor stage) and acquired immunodeficiency syndrome–associated KS (AIDS-KS) accounted for 16 cases (8 in plaque stage and 8 in tumor stage). In both C-KS and AIDS-KS, Bcl-2 immunoreaction correlated with progression stage, its average score intensity being more than 2-fold in tumors than in plaques. In contrast, Bcl-x and Mcl-1 staining intensity was unrelated to progression stage but was dependent on human immunodeficiency virus infection status. Thus, whereas Bcl-x expression was stronger in C-KS cases, Mcl-1 immunostaining was more intense in AIDS-KS instances. These findings indicate that in cutaneous KS, some Bcl-2 family proteins exhibit differential expressions that are dependent on either progression stage or human immunodeficiency virus infection status.

Epidemiology of infections with intestinal parasites and human immunodeficiency virus (HIV) among sugar-estate residents in Ethiopia.

Intestinal parasitic infections could play an important role in the progression of infection with human immunodeficiency virus (HIV), by further disturbing the immune system whilst it is already engaged in the fight against HIV. HIV and intestinal parasitic infections were investigated in 1239, randomly selected individuals, aged 15-54 years, living on a sugar estate in central Ethiopia. Intestinal parasites were identified in faecal samples (one/subject) using direct, concentration, and (for Strongyloides stercoralis larvae) Baermann methods. HIV serological status was determined using ELISA, with ELISA-positive samples confirmed as positive by western blotting. Most (70.1%) of the subjects were infected with at least one intestinal parasite and 3.1% were seropositive (but asymptomatic) for HIV. The intestinal parasites identified in the study population were amoebic parasites (Entamoeba histolytica/Enta. dispar) (24.6%), hookworms (23.8%), Ascaris lumbricoides (22.2%), Trichuris trichiura (19.5%), S. stercoralis (13.0%), Taenia saginata (4.5%), Giardia lamblia (3.0%), and Enterobius vermicularis (1.3%). Overall, the HIV-positives were no more or less likely to carry intestinal parasites than the HIV-negatives (76.2% v. 69.9%; P > 0.05). However, when each parasite was considered separately, amoebic parasites were found to be more common in the HIV-positives than the HIV-negatives (43.7% v. 24.0%; P < 0.05). This difference remained significant in a multivariate analysis, after controlling for the socio-demographic characteristics of the study participants. In conclusion, there was moderate interaction between intestinal parasites and HIV at the asymptomatic stage of HIV infection. The observed association between amoebic and HIV infections requires confirmation in a prospective study, allowing for the analysis of biological mechanisms involved in the association.

Epidemiology of infections with intestinal parasites and human immunodeficiency virus (HIV) among sugar-estate residents in Ethiopia

Intestinal parasitic infections could play an important role in the progression of infection with human immunodeficiency virus (HIV), by further disturbing the immune system whilst it is already engaged in the fight against HIV. HIV and intestinal parasitic infections were investigated in 1239, randomly selected individuals, aged 15–54 years, living on a sugar estate in central Ethiopia. Intestinal parasites were identified in faecal samples (one/subject) using direct, concentration, and (for Strongyloides stercoralis larvae) Baermann methods. HIV serological status was determined using ELISA, with ELISA-positive samples confirmed as positive by western blotting. Most (70.1%) of the subjects were infected with at least one intestinal parasite and 3.1% were seropositive (but asymptomatic) for HIV. The intestinal parasites identified in the study population were amoebic parasites (Entamoeba histolytica/Enta. Dispar) (24.6%), hookworms (23.8%), Ascaris lumbricoides (22.2%), Trichuris trichiura (19.5%), S. stercoralis (13.0%), Taenia saginata (4.5%), Giardia lamblia (3.0%), and Enterobius vermicularis (1.3%).Overall, the HIV-positives were no more or less likely to carry intestinal parasites than the HIV-negatives (76.2% v. 69.9%; P > 0.05). However, when each parasite was considered separately, amoebic parasites were found to be more common in the HIV-positives than the HTV-negatives (43.7% v. 24.0%; P < 0.05). This difference remained significant in a multivariate analysis, after controlling for the socio-demographic characteristics of the study participants. In conclusion, there was moderate interaction between intestinal parasites and HIV at the asymptomatic stage of HIV infection. The observed association between amoebic and HIV infections requires confirmation in a prospective study, allowing for the analysis of biological mechanisms involved in the association.

Infectious Complications of 393 Peripherally Implantable Venous Access Devices in HIV-Positive and HIV-Negative Patients

To compare and investigate the rate of infection in patients with and without human immunodeficiency virus (HIV) who have implantable venous access devices placed by interventional radiologists. Three hundred ninety-one patients undergoing radiologically guided placement of peripheral arm ports were grouped according to their HIV serologic status. Findings were prospectively reviewed in 393 peripherally placed arm ports that were implanted in the basilic, cephalic, or brachial vein under fluoroscopic or sonographic guidance over a 4-year span. Infectious complications were categorized according to severity (local or systemic) and time (periprocedural or late). Three hundred ninety-three ports have been indwelling for a total of 97,256 patient days (range, 1-694; mean duration, 247 days). Among the 30 catheter placements in 29 HIV-positive patients with a total exposure time of 7,242 days, five (one local and four systemic) infections occurred, resulting in a 16.6% overall infection rate, yielding 0.069 infections per 100 catheter days at risk (95% confidence interval [CI], 0.032-0.127). In the remaining 362 HIV-negative patients, 27 (14 local and 13 systemic) infectious complications (7.4%) occurred, translating into 0.030 infections per 100 catheter days (95% CI, 0.021-0.042). The odds ratio of getting an infection from the implantable arm ports in the HIV-positive group was 2.5 times higher than that of the HIV-negative group. The relative risk was similar and was calculated to be 2.3. The P value was .084 (P < .05 required to be considered significant). These results suggest a significant difference in the infectious complication rate encountered in HIV-positive patients compared with the general population. However, the HIV-positive peripheral arm port infection rate compares favorably with the surgically placed catheters and ports. Many more arm ports in HIV-positive patients must be evaluated for the data to achieve an acceptable level of statistical significance.

Personality disorders predict onset of Axis I disorders and impaired functioning among homosexual men with and at risk of HIV infection.

A longitudinal study was conducted to investigate whether personality disorders (PDs) increase risk for the development of future Axis I disorders and serious functional impairment among human immunodeficiency virus (HIV)-seropositive and HIV-seronegative homosexual men. Baseline assessments of PDs, Axis I disorders and symptoms, and Global Assessments of Functioning were conducted with a community sample of 107 (66 HIV-positive and 41 HIV-negative) homosexual men participating in a longitudinal study with semiannual interviews over 3 years. Logistic regression analysis indicated that PDs predicted onset of subsequent Axis I disorders after controlling for both HIV status and lifetime Axis I history (adjusted odds ratio, 4.31; P=.01; 95% confidence interval, 1.39 to 13.32). Of the 21 participants with PDs, 16 (76%) were subsequently diagnosed with Axis I disorders on at least one occasion. By contrast, only 36 (42%) of the 86 participants without PDs were subsequently diagnosed with Axis I disorders. Further, 33% of the participants with PDs, in comparison with only 8% of those without PDs, were assigned Global Assessments of Functioning scores of 50 or lower, indicating serious impairment during the postbaseline study period (adjusted odds ratio, 5.70; P<.005; 95% confidence interval, 1.66 to 19.53). Personality disorders may contribute to increased risk for onset of Axis I disorders and serious impairment among homosexual men regardless of HIV serologic status.

Radiographic abnormalities in tuberculosis and risk of coexisting human immunodeficiency virus infection. Results from Dar-es-Salaam, Tanzania, and scoring system.

First, we evaluated the age profile and chest radiographic abnormalities in 146 patients from Dar-es-Salaam, Tanzania, with new-onset intrathoracic tuberculosis (pulmonary, pleural, or hilar/mediastinal adenopathy), to identify features that were associated with human immunodeficiency virus (HIV) seropositivity or seronegativity; then, we combined these data with those from a companion investigation in Burundi to develop a simple scoring system to predict HIV serologic status. Using agreed-upon criteria and simplified reporting forms, initial chest radiographs were reviewed by three readers, first independently and then at a consensus conference. Of the 146 patients, 80 (55%) were HIV seropositive and 66 were seronegative. More seropositive than seronegative subjects were 31 to 40 yr old (p = 0.03). Because the radiographic characteristics of the two serologic groups were similar in Tanzania and Burundi, we combined the data for stepwise logistic regression that revealed four highly significant variables: age, small lesions, location, and lymphadenopathy. From these, we obtained an equation to calculate the probability that a given tuberculosis patients was HIV seropositive and then we derived a scoring system that in its simplest form (threshold) predicted serologic status correctly in 68.1% of patients; a graded scale was even more accurate in the high (89.1%) and low (82.6%) ranges. This scoring system should be useful when serologic testing is unavailable or refused.

The incidence of the human immunodeficiency virus in injured patients in Lusaka

Patients may present with pathology that is not directly related to their primary complaint. The possibility of the presence of an infecting agent may not be considered and precautions that should be taken may be inappropriately forsaken. A multispeciality study is being undertaken at the University of Zambia to assess the influence of the human immunodeficiency virus (HIV) on the presentation, treatment and outcome of surgical pathology. This study examines the HIV status of 100 patients presenting through the Accident Department with long bone fractures. Assessment using the World Health Organization (WHO) clinical staging system for HIV disease has been compared with the patient's response to the potential immunological challenge and HIV serological status. Thirty-two per cent of adults in the age range 16–55 years were seropositive for HIV but this rose to 50 per cent in those aged between 21 and 40 years. The majority of patients were male, but both sexes had similar patterns of serological status. All patients were in WHO stage 0, 1 or 2 but assessment with the WHO clinical criteria alone led to a high level of diagnostic inaccuracy. Clinical assessment of 18 patients suggested freedom from HIV influence but their serum was seropositive on ELISA testing. The absolute lymphocyte count was below 2000 cells/mm 3 in patients found to be seropositive and with disease of clincial stage 1 or 2.