Human Immunodeficiency Virus Seronegative Patients Research Articles

DOP17 HIV infection is associated with a less aggressive phenotype of inflammatory bowel disease. A multicenter study based on the ENEIDA registry.

Abstract Background The coexistence of immune-mediated diseases and non-pharmacological immunosuppression states are rare and might determine the natural history of the disease and therapeutic decisions of the physician. IBD guidelines recommend screening for human immunodeficiency virus (HIV) before starting immunosuppressive treatment, but data on the impact of HIV infection on IBD and its management in the era of biological drugs are scarce. Therefore, our aim was to describe IBD phenotype, immunosuppressive requirements, and prevalence of opportunistic infections (OI) in patients with IBD and coexistent HIV infection. Methods Case-control, retrospective, multicenter study including all IBD patients with available HIV serology on the ENEIDA registry (a large, prospectively maintained database of the Spanish Working Group in IBD –GETECCU). IBD patients with positive HIV serology were selected (HIV+) and compared to HIV seronegative IBD patients (controls), matched 1:3 by year of IBD diagnosis, age, gender and type of IBD). Demographic, clinical IBD characteristics, therapeutic requirements, OI and IBD complications were registered. Results Eighty-eight HIV+ IBD patients and 264 controls were included. In the whole cohort, 81% were men, 56.8% had ulcerative colitis (UC), 36.4% Crohns’ disease (CD) and 6.8% IBD unclassified. Median age at IBD diagnosis was 38 years (IQR 30-47), median age at HIV infection diagnosis was 36 years (IQR 30-42), 46.3% being were firstly diagnosed of IBD. Among UC patients, HIV+ had a lower proportion of extensive disease (24.5% vs 44.8%; P=0.002), and a higher proportion of proctitis (38.8% vs. 16.6%; P=0.002) than controls, without differences on disease proximal progression (7.7% vs 7.9%). Among CD patients, HIV+ presented a higher proportion of colonic involvement than controls (40.6% vs 12,6%, P=0.002) and lower penetrating behavior (10.7% vs 25%; ns). HIV+ had a lower proportion of extraintestinal manifestations (10.7% vs 25.4%; P=0.005). Although it was not statistically significant, a trend towards a lower proportion of hospitalizations (25.6% vs 35.3%) and IBD complications (6.3% vs. 9.2%) in HIV+ was observed. Regarding IBD therapeutic requirements, immunosuppressant (40.5% vs 58.7%; P=0.003) and biological drugs (28.3% vs 42.8%; P=0.020) were used less frequently among HIV+ than among controls. Conversely, HIV+ had a higher rate of OI (38.3% vs 17.8%; P<0.001) and malignancies (12.5% vs 8.3%, ns) than controls. Conclusion The coexistence of IBD and HIV infection seems to be associated with a less aggressive IBD phenotype and a lower use of immunosuppressants and biologicals but with a remarkable rate of OI.

Unusual presentation of classical Kaposi Sarcoma: penile involvement in an HIV sero-negative patient

Background: Kaposi's sarcoma (KS) is a multifocal, angioproliferative malignant lesion originating from lymphatic endothelial cells. KS limited to the penis is extremely rare in human immunodeficiency virus (HIV) sero-negative patients. In this study, we aimed to present a case of isolated primary penile KS unrelated to HIV. Case Presentation: A 65-year-old man, with no risk factors for KS, presented with reddish nodules on penis. Biopsy was recommended to the patient for definitive diagnosis. Histopathological examination revealed that the diagnosis was classical type KS. No distant metastases were detected. No recurrence or disease progression was detected during the 4-year follow-up. Conclusion: Isolated primary penile KS is extremely rare in HIV sero-negative patients, but it should be kept in mind in the differential diagnosis of pigmented and nodular lesions in the penis. Excision of lesions with negative surgical margins has a high success and very low complication rate, as in our case.

Maxillary Sinus Tuberculosis: Various Presentations

Tuberculosis (TB) of the maxillary sinus is rare. We describe the clinical presentation, management and outcome in two human immunodeficiency virus (HIV) seronegative patients with histopathologically confirmed maxillary sinus TB. One of the patients who presented earlier in the course of the disease could be managed with antituberculosis treatment alone, while the other who presented late required surgical intervention as well.

Clinical Significance of Plasma CD9-Positive Exosomes in HIV Seronegative and Seropositive Lung Cancer Patients

Simple SummaryThe role of exosomes in HIV (human immunodeficiency virus) as well as in cancer patients seems to be pivotal. The aim of our retrospective study was to assess the potential clinical value of CD9-positive plasma exosomes in lung cancer patients, patients with lung granulomas, healthy individuals, and HIV-positive patients with or without lung cancer. This study shows that CD9-positive plasma exosome concentrations differ between healthy controls, patients with immunocompetent pulmonary granulomas and patients with lung cancer. In addition, CD9-positive plasma exosomes are increased in HIV seropositive and HIV seronegative lung cancer patients compared to healthy controls, while chemotherapy-treated lung cancer patients have lower plasma exosome levels. This study also shows that in chemotherapy-naïve patients, plasma exosome levels are directly correlated with a prognosis with higher concentrations being associated with a longer, overall survival. These findings further support previous literature on the translational significance of total plasma exosomes in cancer patients, despite different immunological contexts.Recently, the role of exosomes in the progression of both cancer and HIV (human immunodeficiency virus) has been described. This study investigates the clinical significance of CD9-positive plasma exosomes in lung cancer patients, healthy individuals, and HIV-positive patients with or without lung cancer. Using a verified with transmission electron microscopy double-sandwich ELISA technique, plasma-derived exosomes were isolated and quantified from 210 lung cancer patients (including 44 metastatic patients with progressive disease after chemotherapy), 49 healthy controls, 20 patients with pulmonary granulomas, 19 HIV+ patients with lung cancer, 31 HIV+ patients without cancer, and 3 HIV+ patients with pulmonary granulomas. Plasma exosome concentrations differed between healthy controls, patients with immunocompetent pulmonary granulomas and patients with lung cancer even after chemotherapy (p < 0.001). Lung cancer patients after chemotherapy had lower exosome concentrations compared to patients with untreated lung cancer or granuloma (p < 0.001 for both). HIV+ patients without lung cancer had significantly higher exosome concentrations compared to HIV+ patients with lung cancer (p = 0.016). Although exosome concentrations differed between all different lung cancer histologies and healthy controls (p < 0.001 for all histologies), adjusted statistical significance was oµy retained for patients with granulomas and SCLC (Small-cell lung cancer, p < 0.001). HIV-induced immunodeficient patients with or without lung cancer had lower plasma exosomes compared to immunocompetent granuloma and lung cancer patients (p < 0.001). Finally, higher plasma exosomes were associated both on univariate (p = 0.044), and multivariate analysis (p = 0.040) with a better 3-year survival in stage II and III NSCLC (Non-small-cell lung carcinoma) patients. In conclusion, our study shows that CD9-positive plasma exosomes are associated with both lung cancer and HIV, prior chemotherapy, as well as with survival, suggesting a possible prognostic value.

Regorafenib therapy for hepatocellular carcinoma in a HIV‐1‐infected patient: A case report

Regorafenib therapy for hepatocellular carcinoma in a HIV‐1‐infected patient: A case report

Human immunodeficiency virus infection amongst newly diagnosed tuberculosis patients and their clinico-radiological profile: A prospective study from Western India.

Background:Since time immemorial tuberculosis (TB) has been and continues to be one of the most significant infections causing human disease. In tropical countries, TB remains a leading cause of death. Human immunodeficiency virus (HIV) epidemic continues to fuel this global TB epidemic. The rapid growth of the HIV epidemic in many countries has resulted in an equally dramatic rise in the estimated number of new TB cases, which present therefore the integration of HIV and TB testing at the primary level is need of the hour.Methods:A prospective study was conducted on newly diagnosed, untreated TB patients aged 15-45 year and patients were screened for HIV infection. Clinico-radiological spectrum of TB among HIV seropositive and seronegative patients was evaluated.Results:Out of a total of 307 patients screened, 17 (5.54%) were found to be HIV seropositive. Seroprevalence was found significantly (P < 0.01, χ2 9.301) more common in 26-35 year age group and higher in Extrapulmonary TB (EPTB) patients than that in pulmonary TB (PTB) patients (9.90% vs 3.4%). Fever was the most common presenting symptom for TB in HIV seropositive patients. On examination pallor (58.82% vs. 15.86%), oral ulcer (35.3% vs. 0.35%) was found more common and on chest X-ray mid-lower zone involvement and mediastinal lymphadenopathy were more common in HIV seropositive patients.Conclusion:HIV seropositivity rates among newly diagnosed TB patients aged 15-45 year was 5.54 percent. The presentation of TB was more often atypical among these patients. Thus, an integrated model of TB and HIV at primary healthcare service delivery is an efficient use of resources that would address the two very important co-epidemics and thereby result in better management.

English

Tuberculosis (TB) has become a global health challenge; it is a serious problem in sub-Saharan Africa, where rates of Human Immunodeficiency Virus (HIV) co-infection and drug resistance are high. The prevalence and rifampicin (RIF) resistance of Mycobacterium tuberculosis (MTB) among patients attending Federal Medical Centre Makurdi, Benue State was investigated. Sputum samples collected from 200 patients were tested for acid-fast Bacilli (AFB) using Ziehl-Neelsen stain. GeneXpert machine was used to test the resistance of the AFB to rifampicin. The prevalence of TB was 25.5% and the infection rate was higher in males (28.3%) than in females (23.1%), even though the difference was not statistically significant (2=0.684; p&gt;0.05). The prevalence of TB among HIV patients was also investigated. Prevalence of TB in HIV sero-positive patients was 22.2 and 28.9% in HIV sero-negative patients. This difference, however, was not statistically significant (2=4.453; p&gt;0.05). Most (70.6%) of the AFB positive specimens were susceptible to rifampicin; only a few (29.4%) were resistant to it (2=43.377; p&lt;0.05). With the high prevalence of TB and the high rifampicin resistance (MDR-TB) in Benue State, policy makers and government should increase budgetary allocations for TB control and prevention through sourcing or appealing to international organizations for finance. In addition, the government should encourage research for the development of new and better TB vaccines by financing the project. Key words: Prevalence, resistance, Mycobacterium tuberculosis, Makurdi. &nbsp

A Road Less Travelled: Clinical Comparison of HIV Seropositive and Seronegative Patients with Cystoisosporiasis – An 11-Year Experience from a Tertiary Care Centre in Northern India

Background:Cystoisospora is a well-known opportunistic enteric parasite among human immunodeficiency virus (HIV) seropositive patients but there is a paucity of data among HIV negative patients. This study investigated Cystosporiasis on both HIV positive and negative patients, with or without diarrhea, presenting to a tertiary care and super specialty center of northern India. Methodology:Oocysts of Cystoisospora were detected on light microscopy, by modified Kinyoun staining of stool specimens, over an 11-year study period. Results: Of the 10,233 stool specimens evaluated, Cystoisospora was detected in 64 patients, 37 (57.81%) of whom were HIV positive. Year-wise analysis showed an overall declining trend of cystoisosporiasis. Maximum cases were detected in May and June in HIV positive patients and February and September among HIV negative patients. Among HIV positive patients, the mean CD4 count was 152.04 ± 81.12cells/μL, mean absolute eosinophil count (AEC) was 229.16 ± 175.62 cells/μL and 12.5% patients had mild eosinophilia. Tuberculosis was the most common co-morbidity. Dual infections of Cystoisospora with Cryptosporidium and Giardia were also seen. Among HIV negative patients, eight had primary autoimmune disorders, seven were solid organ transplant recipients and the rest had chronic bowel diseases. The mean AEC was 485.47 ± 414.88 cells/μL, with 14.81% patients showing mild and 11.11% showing marked eosinophilia. Dual infection with Giardia was seen. Recurrent cystoisosporiasis was noted, despite cotrimoxazole treatment in a single case. Conclusion: The epidemiology of cystoisosporiasis differs between HIV seropositive and seronegative patients in terms of year-wise and month-wise trends, co-infections and most importantly, AECs.

Comparison of Cerebrovascular Risk between Elderly Human Immunodeficiency Virus-seropositive Patients Treated with Highly Active Antiretroviral Therapy and Human Immunodeficiency Virus-seronegative Patients

Introduction: The current era of AIDS is characterized by an aging of population and increase in the incidence of non-acquired immune deficiency syndrome-related diseases. The aim of the present study was to compare the cerebrovascular risk in elderly HIV(+) patients under HAART therapy with seronegative elderly. Materials and method: This transversal study was performed between January 2011 and December 2013, and evaluated 2 groups of individuals older than 60 years. The first group included elderly HIV(+) patients who had been receiving HAART for over 1 year, and the second group included elderly HIV(−) patients. To detect cerebrovascular risk in groups, anthropometric assessments (body mass index and waist circumference), clinical evaluations (Framingham score), and laboratory assessments (carotid Doppler ultrasonography and brain magnetic resonance imaging [MRI]) were performed. Results: The HIV(+) group included 26 patients and the HIV(−) group included 40 patients. The cerebrovascular risks based on body mass index (P=0.001), the Framingham score (P=0.02), and the presence of lesions on MRI (P=0.03) were lower in the HIV(+) group than in the HIV(−) group. Moderate to severe cerebrovascular risk according to the Framingham score was 3 times more likely among infected patients than among non-infected patients (P=0.03). Additionally, patients who had received more than 10 years of HAART had a 90% lower chance of cerebrovascular disease if they presented with a Framingham score indicating moderate to high risk than if they presented with a Framingham score indicating mild risk (P=0.03). Conclusion: Our results suggest that the presence of HIV infection in elderly patients might increase the risk of cerebrovascular events. The risk might be low in patients who receive HAART for more than 10 years, indicating that HAART might have the potential to reduce the risk of cerebrovascular events.

Cytomegalovirus Identification and Quantification from the Saliva of Human Immunodeficiency Virus Seropositive and Seronegative Patients Using Real Time Polymerase Chain Reaction

Cytomegalovirus Identification and Quantification from the Saliva of Human Immunodeficiency Virus Seropositive and Seronegative Patients Using Real Time Polymerase Chain Reaction

Outbreak of multidrug-resistant tuberculosis in an aboriginal family in eastern Taiwan

Spread of multidrug-resistant tuberculosis (MDR-TB) strains in the general population presents a serious threat to public health and severely threatens existing control efforts. Techniques such as spoligotyping and Mycobacterium interspersed repetitive units—variable-number tandem-repeat typing of mycobacterial isolates have been employed to confirm familial outbreaks of MDR-TB. We diagnosed and traced four MDR-TB cases in a family via genotyping. Despite aggressive treatment, the index case remained culture positive, but the other patients were cured. This is the first documentation of a familial MDR-TB outbreak affecting human immunodeficiency virus-seronegative patients in eastern Taiwan. Molecular techniques are important in the identification of sources of MDR-TB infections. The adult index case in our study developed MDR-TB due to poor compliance with the drug regimen (acquired resistance), followed by transmission of MDR-TB to his children in close household contact. This emphasizes the importance of an effective drug delivery program, such as directly observed treatment, to improve drug compliance and prevent the emergence of drug-resistant cases.

English

AIM: To determine the prevalence of human immunodeficiency virus (HIV) infection among tuberculosis patients, to compare the clinical features of tuberculosis among HIV seropositive and seronegative patients, & to correlate the seropositive tuberculosis patients with the CD4 count. METHODS: This study was undertaken in Gandhi Medical College, Hamidia Hospital, Bhopal, in department of medicine during November 2008 to November 2009. A total of 150 radio logically and / or bacteriologically confirmed patients of tuberculosis were tested for HIV seroprevalence. RESULTS: Among 150 tuberculosis patients, thirteen (8.66%) were found to be HIV seropositive. Eleven (84.6%) were males and two (15.4%) were females. Among 13 HIV seropositive patients ten (76.92%) patients were in the age group of 21 - 40 years. Out of eleven HIV seropositive male patients five (45.45%) were labourers, four (36.36%) were truck drivers, Among HIV seropositive patients, eight (61.53 %) belonged to urban area & five (38.47%) were from rural areas. Eleven (84.6%) had contracted HIV infection through sexual contact, one was IV drug abuser, one was supposed to be infected by blood transfusion. five (38.46%) patients had disseminated/military tuberculosis (DTB/MTB), three (23.07%) patients had pulmonary tuberculosis, three (23.07%) had pleural effusion, two (15.38%) had neurotuberculosis. Ten (76.92%) seropositive patients had CD4 count <350.CONCLUSION: The trend of dual infection with HIV and tuberculosis in the area is rising. Atypical presentation, extrapulmonary and disseminated / military tuberculosis cases are more at CD4 < 350/ml

Lymphogranulomatose vénérienne : nouveau sérovariant L2b et ancien « signe de la poulie »

An ongoing lymphogranuloma venereum (LGV) outbreak has been reported in several European countries since 2003, related to a new variant L2b. This serovar appears to affect men who have sex with men (MSM), most of them being co-infected with the Human Immunodeficiency Virus (HIV). The secondary stage of LGV may involve lymph nodes and the inguinal form has sometimes been described on each side of the inguinal ligament thus named the "groove sign". We report the case of LGV serovariant L2b acquired by an heterosexual intercourse in an HIV seronegative patient who presented with an inguinal lymph node and a "groove sign". This is an uncommon but suggestive sign of LGV and we suggest that the clinical presentation of L2b LGV might not be so different than other variants and than the 20th century authors' description. Such a new Chlamydia trachomatis variant may circulate in other populations than MSM in Europe and clinical awareness must prevail.

Prevalence of multidrug resistance in Mycobacterium tuberculosis isolates from HIV seropositive and seronegative patients with pulmonary tuberculosis in north India

BackgroundMultidrug resistant (MDR) and extensively-drug resistant (XDR) tuberculosis (TB) are a serious threat to the national TB control programs of developing countries, and the situation is further worsened by the human immunodeficiency virus (HIV) pandemic. The literature regarding MDR/XDR-TB is, however, scanty from most parts of India. We carried out this study to assess the prevalence of MDR/XDR-TB in new and previously treated cases of pulmonary TB and in HIV seropositive and seronegative patients.MethodsSputum and blood specimens were obtained from 2100 patients suspected of pulmonary tuberculosis and subjected to sputum microscopy and culture for TB, and HIV serology at our tertiary care centre in north India. The culture positive Mycobacterium tuberculosis isolates were subjected to drug susceptibility testing (DST) for first line anti-tuberculosis drugs, and the MDR isolates were further subjected to second line DST. Various parameters of the patients’ were analyzed viz. clinical presentation, radiology, previous treatment history, demographic and socioeconomic data and microbiology results.ResultsOf the 2100 patients, sputum specimens of 256 were smear positive for acid-fast bacilli (AFB), 271 (12.9%) grew Mycobacterium spp., and M. tuberculosis was isolated in 219 (10.42%). Of the 219 patients infected with M. tuberculosis, 20.1% (44/219) were found to be seropositive for HIV. Overall, MDR-TB was observed in 17.4% (39/219) isolates. There were 121 newly diagnosed and 98 previously treated patients, of which MDR-TB was found to be associated with 9.9% (12/121) and 27.6% (27/98) cases respectively. There was significantly higher association of MDR-TB (12/44, 27.3%) with HIV seropositive patients as compared to HIV seronegative patients (27/175, 15.4%) after controlling previous treatment status, age, and sex (odd’s ratio, 2.3 [95% CI, 1.000-5.350]; p-value, 0.05). No XDR-TB was found among the MDR-TB isolates.ConclusionThe present study demonstrated a high prevalence of drug resistance amongst pulmonary TB isolates of M. tuberculosis from north India as compared to the WHO estimates for India in 2010, though this could possibly be attributed to the clustering of more serious or referred cases at our tertiary care centre. The prevalence of MDR-TB in HIV seropositive patients was significantly higher than seronegative individuals. The study emphasizes the need to monitor the trends of drug resistance in TB in various populations in order to timely implement appropriate interventions to curb the menace of MDR-TB.

Comparative study on the microbiological features of angular cheilitis in HIV seropositive and HIV seronegative patients from South India

Objective:This study was designed to compare the microbiological features of angular cheilitis (AC) in human immunodeficiency virus (HIV) seropositive and HIV seronegative individuals, in a group of south Indians.Materials and Methods:Swabs from oral commissures of 46 patients were obtained and inoculated on to Sabouraud's dextrose agar (SDA) supplemented with chloramphenicol, blood agar (BA) and MacConkey's agar (MCA) plates and cultured. α-hemolytic Streptococci, Staphylococcus albus, Staphylococcus aureus, Candida species, Klebsiella species and Pseudomonas species were cultured. Candidal colonies were further speciated by the conventional biotyping technique.Results:In AC of HIV seropositive patients Candida albicans and Staphylococcus aureus were more prevalent than that in HIV seronegative patients. Incidentally in patients with CD4 cell count less than 200 there was an increase in the incidence of Candidal and Staphylococcus aureus colonization when compared to patients with CD4 cell count higher than 200.Conclusion:The present study suggests a definite difference in the microbial flora of AC in HIV seropositive patients than that of HIV seronegative population.

Disseminated histoplasmosis with oral and cutaneous manifestations

Histoplasmosis is a systemic mycotic infection caused by the dimorphic fungus, Histoplasma capsulatum. Systemic histoplasmosis has emerged as an important opportunistic infection in human immunodeficiency virus (HIV) patients and those in endemic areas. Reported cases of histoplasmosis have been low in India with less than 50 cases being reported. We are reporting a case of disseminated histoplasmosis with oral and cutaneous involvement in an HIV seronegative patient.

English

BACKGROUND: Difference in expression of virulence factors and in antifungal susceptibility among different Candida species has raised the need for species-level identification. Opportunistic infection is usually caused by Candida albicans, however, over the last decade reports of non-albicans Candida causing this infection is increasing. AIM: The present study was undertaken to assess the role of various Candida species as opportunistic pathogens in Human Immunodeficiency Virus (HIV) seropositive patients and testing their antifungal susceptibility pattern. METHODS AND MATERIAL : 100 clinical samples were obtained from HIV seropositive patients and 50 from HIV seronegative patients and were speciated by the conventional methods and also by HiCrome Candida Differential Agar (CHROM agar). Susceptibility testing of the isolates for Fluconazole and Itraconazole was performed by Macro broth dilution technique. RESULTS: Candida albicans was the commonest species isolated followed by C.dubliniensis, C.parapsilosis, C.tropicalis, C.krusei and C.glabrata. Antifungal susceptibility testing from HIV seronegative patients showed all Candida albicans and Candida tropicalis isolates were sensitive to both Fluconazole and Itraconazole. Candida krusei (1 isolate), Candida glabrata (1 isolate), Candida dubliniensis (3 isolate) showed resistance to Fluconazole and Candida parapsilosis (1 isolate) showed dose-dependent susceptibility with MIC = 16 μg/ml. Itraconazole resistance was observed for Candida krusei (1 isolate), Candida glabrata (1 isolate), with an MIC range of ≥1 mg/L. All other isolates, even which were resistant to Fluconazole were sensitive to Itraconazole. All Candida isolates from HIV seronegative patients were sensitive to both Fluconazole and Itraconazole. CONCLUSION: Increasing trend of Non albicans Candida species causing various invasive infections and their prevalence in a particular geographical area warrant the need of speciation of Candida species. The long-term use of azoles as prophylaxis for Invasive candidiasis can result in the selection of Candida isolates that are more resistant to azole therapy. The non albicans Candida species like C.glabrata and C. krusei are more resistant to Fluconazole and Itraconazole compared to C. albicans. Hence the antifungal susceptibility pattern plays an important role for successful treatment of Candidiasis. The use of Macrobroth dilution method using BHI broth technique will help in detecting the antifungal susceptibility pattern in a less equipped laboratory.

Gastrointestinal and urinary tract pathogenic infections among HIV seropositive patients at the Komfo Anokye Teaching Hospital in Ghana

BackgroundGastrointestinal and urinary tract pathogenic infections are aggravating the incidence and progression of the Human Immunodeficiency Virus (HIV) infection into Acquired Immune Deficiency Syndrome (AIDS) more especially in the developing countries. This study was conducted to assess the common gastrointestinal and urinary infections among HIV/AIDS patients at the Komfo Anokye Teaching Hospital (KATH) in Ghana between April and December 2008.FindingsThis work reports on gastrointestinal and urinary tract pathogenic infections among 500 HIV seropositive and 300 HIV seronegative patients. There was a 35% (175/500) prevalence of intestinal parasites among HIV seropositive patients compared to 4.3% (13/300) in HIV seronegative patients. Giardia lamblia and Cryptosporidium accounted for 19% (95/500) and 14% (70/500) respectively, while Schistosoma mansoni, Strongyloides stercoralis and hookworm together accounted for 2% (10/500) of intestinal parasitic infections among the HIV seropositive patients. There was no significant difference (p > 0.05) in urinary parasitic infection between HIV seropositive 1% (2/500) and seronegative patients 0.7% (2/300). Most, 60 (86%) out of 70, of the urinary tract infection among the HIV seropositive patients was due to bacteria with E. coli being the most predominant isolate, 28 (47%) out of 60. There was no significant difference in infections based on age and gender.ConclusionG. lamblia and Cryptosporidium were the most common gastrointestinal parasites detected while bacteria accounted for majority of the urinary tract infections among the HIV seropositive patients at the hospital.

Role of QuantiFERON-TB Gold, Interferon Gamma Inducible Protein-10 and Tuberculin Skin Test in Active Tuberculosis Diagnosis

BackgroundThe measurement of Interferon gamma or Interferon gamma inducible protein (IP)-10 in antigen stimulated blood samples is suggested as an alternative method for latent tuberculosis (TB) diagnosis. Nonetheless, their role in active TB diagnosis, particularly in TB endemic settings is yet to be defined. In this study, the sensitivities and specificities of Interferon gamma release assay (IGRA), IP-10 assay and tuberculin skin test (TST) in detecting active TB cases were assessed in human immunodeficiency virus (HIV) sero-negative TB patients and healthy controls respectively.Methods/Principal FindingsA total of 177 adult TB patients and 100 healthy controls were included for this study. QuantiFERON-TB Gold In-tube (QFT-IT) method was used to analyze the sensitivity and specificity of IGRA. QFT-IT, IP-10 and TST yielded the diagnostic sensitivities of 90.6% (95%CI: 86.3%–94.9%), 92.5% (95%CI: 88.6%–96.4%) and 68.9% (95%CI: 60.6%–77.2%) and specificities of 55% (95% CI: 35.2%–54.8%), 48% (95% CI: 38.2%–57.8%) and 75.5% (95% CI: 66.8%–84.2%), respectively. The extent of pulmonary involvement or presence of diabetes mellitus did not appear to influence the sensitivities of any of these tests. The combination of any of the two tests among QFT-IT, IP-10 and TST showed >98% sensitivity among smear negative cases and particularly the combination of IP-10, TST and smear microscopy showed 100% sensitivity, however, the specificity was decreased to 44.8%.Conclusions/SignificanceQFT-IT and IP-10 were highly sensitive in detecting active TB cases. The combination with TST improved the sensitivity of QFT-IT and IP-10 significantly. Although the higher sensitivity of combination of QFT-IT/IP-10 and TST may be useful in active TB diagnosis, they are limited by their poor specificity due to the high prevalence of latent TB in our settings.

HIV Infection Is Associated with a Lower Incidence of Constriction in Presumed Tuberculous Pericarditis: A Prospective Observational Study

BackgroundPericardial constriction is a serious complication of tuberculous pericardial effusion that occurs in up to a quarter of patients despite anti-tuberculosis chemotherapy. The impact of human immunodeficiency virus (HIV) infection on the incidence of constrictive pericarditis following tuberculous pericardial effusion is unknown.Methods and ResultsWe conducted a prospective observational study to determine the association between HIV infection and the incidence of constrictive pericarditis among 185 patients (median age 33 years) with suspected tuberculous pericardial effusion. These patients were recruited consecutively between March and October 2004 on commencement of anti-tuberculosis treatment, from 15 hospitals in Cameroon, Nigeria and South Africa. Surviving patients (N = 119) were assessed for clinical evidence of constrictive pericarditis at 3 and 6 months of follow-up. Clinical features of HIV infection were present in 42 (35.2%) of the 119 patients at enrolment into the study. 66 of the 119 (56.9%) patients consented to HIV testing at enrolment. During the 6 months of follow-up, a clinical diagnosis of constrictive pericarditis was made in 13 of the 119 patients (10.9 %, 95% confidence interval [CI] 5.9–18%). Patients with clinical features of HIV infection appear less likely to develop constriction than those without (4.8% versus 14.3%; P = 0.08). None of the 33 HIV seropositive patients developed constriction, but 8 (24.2%, 95%CI 11.1–42.3%) of the 33 HIV seronegative patients did (P = 0.005). In a multivariate logistic regression model adjusting simultaneously for several baseline characteristics, only clinical signs of HIV infection were significantly associated with a lower risk of constriction (odd ratio 0.14, 95% CI 0.02–0.87, P = 0.035).ConclusionsThese data suggest that HIV infection is associated with a lower incidence of pericardial constriction in patients with presumed tuberculous pericarditis.