Human Immunodeficiency Virus Seropositive Women Research Articles

Determinants of cervical cancer screening among women living with HIV in Zimbabwe.

In sub-Saharan Africa (SSA), cervical cancer (CC) is the second leading cause of cancer-related deaths, with human immunodeficiency virus (HIV) seropositive women being particularly vulnerable. Despite the benefits of early CC screening in reducing HIV-related CC deaths, CC screening uptake remains limited, with wide disparities in access across SSA. As part of a larger study, this paper examines the determinants of CC screening among HIV-seropositive women of reproductive age (15-49 years) in Zimbabwe. Using the 2015 Zimbabwe Demographic and Health Survey, we conducted multilevel analyses of CC screening among 1490 HIV-seropositive women, nested in 400 clusters. Our findings revealed that, even though 74% of HIV-seropositive women knew about CC, only 17.6% of them reported ever screening for it. Women who held misconceptions about HIV (OR = 0.47, p = 0.01) were less likely to screen for CC compared to those with accurate knowledge about HIV and CC. HIV-seropositive women with secondary or higher education were more likely to screen (OR = 1.39, p = 0.04) for CC compared to those with a primary or lower level of education. Age was positively associated with screening for CC. Furthermore, locational factors, including province and rural-urban residence, were associated with CC screening. Based on these findings, we call for integrated care and management of HIV and non-communicable diseases in Southern Africa, specifically, Zimbabwe due to the legacy of HIV in the region.

Cervical Cytology and Herpes Simplex Virus Type-2 Serology Among Human Immune Deficiency Virus Infected Women on Highly Active Antiretroviral Therapy in Enugu, Nigeria.

The prevalence of Human Immunodeficiency Virus (HIV) and Herpes Simplex Virus type-2 (HSV-2) infections are high and the programme for Cervical Cancer Screening is weak in Nigeria. Prevalence of Herpes Simplex Virus Type-2 co-infection and cervical cytology among HSV-2 co-infected Human Immunodeficiency Virus Sero-positive (HIV+) women on Highly Active Antiretroviral Therapy (HAART) attending Human Immunodeficiency Virus clinic at University of Nigeria Teaching Hospital (UNTH) Ituku/Ozalla Enugu, Nigeria. A cross-sectional, hospital-based study. Active participants included 105 HIV seropositive women on HAART and104 HIV seronegative (HIV-) women who passed inclusion criteria and signed written informed consent. Each participant was coded with a specific number. A structured questionnaire was used to obtain the socio-demographic and medical history. Serum was obtained for HSV-2 serology test for all participants and HIV screening for HIV-negative participants. Cervical smears were collected for Papanicolaou stains and Immunocytochemistry using anti-P16INKa antibody. Prevalence of HSV-2+ was 50.5% among HIV+ women on HAART and 16.3% among HIV- women, Odds Ratios [95% CI]; p-value was 5.21 [2.74-9.94]; p < 0.0001. HIV+ women on HAART co-infected with HSV-2 significantly had more Cervical Lesions, 11.4% compared to HIVwomen uninfected with HSV-2, 4.8%, OR [95% CI]; p-value 4.8 (1.58-14.54); p = 0.006. The prevalence of HSV-2 was significantly high among HIV+ women on HAART. HSV-2+ co-infection could be an enhancer of Cervical Lesions among HIV+ women on HAART. Hence, anti-herpetic agent introduction and screening for HSV-2 among HIV+ patients are recommended.

Abstract 1496: Circulating mir21 and mir125b in women living with human immunodeficiency virus: Utility of biomarkers for monitoring cervical carcinogenesis

Abstract Background: As of 2018, the prevalence of Human immunodeficiency virus (HIV), and cervical cancer (Ca) attributable to HIV was higher in Africa than in other continents. Identifying individuals at a high risk of developing Ca among immunocompromised persons, using less invasive techniques, remains a major challenge. Purpose: The study evaluated HIV infection-associated dysregulation of Ca-linked oncomirs (miR-21, miR-146a, miR-155, miR-182, and miR-200c) and tumor suppressors (miR-let-7b, miR-125b, miR-143, miR-145, and p53 gene), in a bid to identify early indicators of genetic instability, and biomarkers for monitoring of high-risk individuals. Methods: This case-control study included 173 women without abnormal Pap smear; confirmed HIV seropositive women (HIV+ = 103) and HIV seronegative women (HIV- = 70). Relative expressions of miRNAs and p53 gene in blood and cervical cells) were determined following RNA extraction, reverse transcriptase Polymerase Chain Reaction (PCR), and gel electrophoresis. T-test was used to compare the data from HIV+ and HIV- women. Significance was set at p≤ 0.05. Results: Similar pattern of miR-21, miR-146a, miR-182, miR-200c, miR-125b, and miR-145 expression was observed in both samples. Higher expressions of miR-155 and p53 gene were observed in cervical cells of HIV+ women compared with HIV- women (p= 0.046, and 0.033, respectively) whereas lower expressions of miR-155 and p53 gene were observed in the blood of HIV+ women compared with HIV- women (p= 0.539 and 0.049, respectively). In both blood and cervical cells, higher miR-21 expression (p= 0.032 and 0.198, respectively) and lower miR-125b expression (p= 0.050 and 0.004, respectively) were observed in HIV+ women compared with HIV-women. In blood, a lower expression of miR-146a was observed in HIV+ women compared with HIV- women (p= 0.036) whereas in cervical cells, lower expressions of miR-182 and miR-200c were observed in HIV+ women compared with HIV- women (p= 0.035 and 0.045, respectively). The low expression of miR-146a, miR-182, and miR-200c in HIV+ women could be due to immune exhaustion, viral immune evasive mechanism, or an indicator of viral latency while the higher expression of miR-21, and lower expression of miR-125b and p53 could be early indicators of genetic instability prior to epithelial transformation. Conclusion: This study suggests that circulating high expression of miR-21 and low expression of miR-125b and p53 gene could be used in identifying individuals at risk of developing Ca, especially among immunocompromised patients. Keywords: Human immunodeficiency virus, Cervical cancer, Detection, Biomarkers, MicroRNAs Citation Format: Jude Ogechukwu Okoye, Anthony Ajuluchukwu Ngokere, Charles Chinedum Onyenekwe, Samuel Ifedioranma Ogenyi, Olaposi Omotuyi. Circulating mir21 and mir125b in women living with human immunodeficiency virus: Utility of biomarkers for monitoring cervical carcinogenesis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1496.

Occurrence Rate of Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) Co - infection among Expectant Mothers Attending Antenatal Clinic in Rivers State University Teaching Hospital

The global burden of co-infection with human immunodeficiency virus (HIV), hepatitis B and C virus (HBV and HCV) has a negative impact in Sub-Saharan Africa.When HIV, HBV and HCV co-exist, they become life threatening and with high fatality rate particularly in gestation in which transmission occurs vertically, causing fetal and neonatal hepatitis. The study aimed at examining the occurrence rate of Human Immunodeficiency Virus (HIV), Hepatitis B virus (HBV) and Hepatitis C Virus (HCV) co - infection among expectant mothers attending antenatal clinic in Rivers State University Teaching Hospital (RSUTH). The study population comprised of one hundred and fifty (150) pregnant women. Venous blood was used in the study and screened for hepatitis B surface antigen (HBsAg), anti-HCV, and anti-HIV antibodies using commercially available immunoassay test kits. The prevalence of HCV, HIV and HBsAg among the pregnant subjects in relation to age group 21-30 and 31-40 in the study revealed a seropositive percentage of 0.7% and 1.3%. The other groups, however, showed no positive result among the three viruses. Furthermore, 0.7% of the pregnant women in their first, second and third trimester were co-infected with HCV and HBsAg while 1.3% out of 36.7% and 0.7% out of 61.3% of pregnant women within the age groups 21-30 and 31-40 respectively were seropositive for HIV. In relation to gestational age, it was seen from the study that 0.7% of the pregnant women in their first, second and third trimester were seropositive for HCV and HBsAg respectively, while 2% of the HIV seropositive pregnant women were in their first trimester. The overall seroprevalence of HCV, HIV and HBsAg as revealed in the study showed that infection was found to be 2% respectively among the pregnant women. The reduced prevalence of hepatitis B (HBsAg), hepatitis C (HCV) and human immunodeficiency virus (HIV) infection observed in the study among pregnant women attending antenatal care in the Rivers State University Teaching Hospital may be attributed to the increase in the awareness amongst the general populace in Port Harcourt especially couples about the consequences of sexually transmitted diseases such as HIV, Hepatitis B as well as Hepatitis C. In other words, there is reduction in seroprevalence of HBsAg, HCV and HIV which is premised on the efficacy of sensitization particularly on HBV vaccination and preventive protocols for HIV.

Epidemiological evaluation of maternal periodontal status in human immunodeficiency virus seropositive pregnant women in India

Background: Human immunodeficiency virus (HIV) infection in pregnancy was the most common complication in some developing countries. This has major implications for the management of pregnancy and birth. Periodontal disease in HIV-infected pregnant women leads to a hyperinflammatory state which may have an impact on developing fetus. Aim: The evaluation of gingival and periodontal health in HIV seropositive pregnant women. Methods: A sample of 432 HIV seropositive pregnant women visiting the antiretroviral therapy center from January 2016–December 2016 were included in the present study. Information concerning demographic profile, medical history, and oral health information was recorded in a case sheet pro forma. Several measures of periodontal health such as bleeding on probing, plaque index, pocket depth (PD), and clinical attachment loss were obtained and analyzed by using Chi-square test of independence and P value (P < 0.05, statistically significant). Results: Three hundred and ninety-six participants (91.6%) had gum bleeding on >1 tooth. In gingivitis, the distributions of mild, moderate, and severe gingivitis were about 64 (14.81%), 192 (44.44%), and 140 (32.41%) participants, respectively. Participants without periodontitis (without a single PD ≥4 mm) were about 202 (46.76%). Two hundred and thirty participants (53.2%) had periodontal pockets (≥4 mm) on ≥1 tooth. In periodontitis, the distributions of mild, moderate, and severe periodontitis were 28.70%, 15.74%, and 8.80%, respectively. Conclusion: Ninety-two percent of HIV pregnant women have shown gingival inflammation. Periodontitis was observed in 51% of HIV pregnant women. This observation strengthens the importance of oral health care in HIV-positive pregnant women.

Association between periodontitis and preterm low birth weight in human immunodeficiency virus seropositive pregnant women in India: A cohort study.

Because of the inflammatory response to human immunodeficiency virus (HIV) infection and periodontitis risk of developing adverse pregnancy outcomes are high. There is a limited number of studies available in the literature regarding the association between periodontitis and adverse pregnancy outcomes, especially in HIV infection. So the main objective of the present study was to assess the risk of preterm low birth weight (PTLBW) associated with periodontitis among HIV seropositive pregnant women. The study sample consists of 216 HIV seropositive pregnant women with complete dental and medical history and the appointment for the follow-up visit was made after the delivery to assess the baby's health.Gingivitis and periodontitis were assessed based on the bleeding on probing and clinical attachment levels at the first visit. In our study, the majority of 96 (44.44%) of the gingivitis cases belong to "moderate gingivitis" and the majority of 62 (28.70%) of the periodontitis cases were found to be in the mild periodontitis category. The relative risk for women with gingivitis or periodontitis having a preterm birth, low birth weight, and PTLBW was not statistically significant. The trend of risk ratios was found to be increased over the severity of periodontitis. This study shows an association between adverse neonatal outcomes with moderate and severe periodontitis. But these results were not statistically significant. This study implicates the importance of oral health care in HIV-positive pregnant women.

Prevalence of Human Papillomavirus (HPV) Genotypes in Cervicovaginal Secretions of Human Immunodeficiency Virus (HIV) Positive Indian Women and Correlation With Clinico-Virological Parameters.

Introduction and Background: Both human papillomavirus (HPV) and the human immunodeficiency virus (HIV) are sexually transmitted. High-risk (HR) HPV types are a causal factor in cervical cancer. Persistent HPV infection in this subset of immunocompromised women results in faster disease progression. The study determined the prevalence of HPV genotypes in cervicovaginal secretions of HIV seropositive women and the correlation with CD4 counts and cytology.Method: One hundred, non-pregnant, HIV-positive women of 18 years of age and above were enrolled in this cross-sectional study following approval by the institutional ethical committee. A written consent, questionnaire, followed by sample collection including a Papanicolaou (Pap) smear for cytology was undertaken. Cervicovaginal secretion samples were collected in the Digene® specimen transport medium (STM) (Qiagen Gaithersburg Inc., MD, USA). HPV genotyping was carried out with PCR amplification of a 65-base pair (bp) fragment in the L1 region of the HPV genome using the short PCR fragment (SPF10) primers followed by reverse hybridization by line probe assay (LPA) using the INNOLiPA HPV Genotyping Extra kit (Fujirebio, Belgium). Quantitation of HPV-16 and−18 viral loads (VLs) was done by real-time PCR. Results of Pap smear cytology were correlated with CD4 counts and HPV-16 and−18 VLs.Results: Mean age of the subjects was 34.9 years ± 7.2 years (median 33.0 years, range 24–60 years). HPV was detected in 62 of 93 (66.6%) samples. Twenty (32.25%) of these 62 samples harbored a single HPV genotype. Multiple genotypes (more than two) were detected in 38 (61.3%) samples. HPV-16 was the commonest genotype detected in 26 (27.9%) of all samples and 41.9% of HPV positive samples. Pap smear cytology was reported for 93 women included in the study. Women who had normal cytology were reported as negative for intraepithelial malignancy or lesion (NILM; n = 62; 71.36%), two women had a high-grade squamous intraepithelial lesion (HSIL), low-grade squamous intraepithelial lesion (LSIL; n = 11), atypical squamous cells of undetermined significance (ASCUS; n = 12). Those smears with inadequate material were reported as scant (n = 6). The median CD4 count was 363/cu.mm (range 39–787) in HPV-positive women compared to 423/cu.mm (range 141–996) in those HPV-negative women. Quantitation of HPV-16 and−18 VL was done in duplicate for samples positive by PCR reverse hybridization (INNOLiPA). Of these 20 samples (65%), 12 samples were positive by real-time PCR. The normalized HPV-16 VL ranged between 18 and 240,000 copies/cell. The normalized HPV-18 VL in cervical samples ranged between ~24 and 60,000 copies/cell.Conclusion: HIV-positive women may be infected with multiple genotypes other than HPV-16 and−18. This may have implications on the vaccines available currently which target few specific genotypes only. Studies are required to determine the predictive role of HR HPV genotypes, in significant copy numbers especially in HIV seropositive women. It would be clinically relevant if the HPV VLs, cervical cytology, and CD4 counts are considered into cervical cancer screening programs for triage and follow-up of these women.

Co-existence of Herpes simplex virus type 2 and two other oncoviruses is associated with cervical lesions in women living with HIV in South-Western Nigeria.

The prevalence of Herpes simplex virus type 2 (HSV-2) in cervical lesions is under-reported, especially in Human immunodeficiency virus (HIV), Epstein-Barr virus (EBV) and Human Papillomavirus (HPV) infected persons. This study determined the prevalence of viral mono-infections, co-infections and squamous cell intraepithelial lesions (SIL) in HIV seropositive (HIV+) and HIV seronegative (HIV-) women. This study included HIV+ and HIV- women (105 each). Cervical smears and viral antibodies were evaluated by Papanicolaou's technique and ELISA method, respectively. The prevalence of HSV-2, HPV and EBV infections, and SIL were higher in HIV+ women (75.2, 41.9, 41 and 32.4%) than in HIV- women (45.7, 26.7, 26.7 and 13.3%) at p< 0.0001, p= 0.029, 0.041 and 0.002, respectively. Higher prevalence of viral mono-infection and tri-infection was observed in HIV+ women (43.8 and 24.8%) than in HIV- women (27.6 and 8.6%) at p= 0.021, and 0.003, respectively. The prevalence of SIL was also higher in HIV+ women with viral mono-infection, bi-infection and tri-infection (15.2, 42.9, and 53.8%) than in HIV- women (6.9, 12.5, and 44.4%) at p= 0.468, 0.041, and 0.711, respectively. This study suggests that the high prevalence of SIL in HIV+ women could be associated with viral co-infections.

Seroprevalence of Toxoplasmosis among Human Immunodeficiency Virus infected pregnant women in Abuja Teaching Hospital, Nigeria

Introduction. Toxoplasmosis is a neglected parasitic infection that has economic and epidemiological significance. Data on toxoplasmosis seroprevalence among Human Immunodeficiency Virus (HIV) infected pregnant women may be of obstetric and neonatal concern. Aim. The study was designed to determine the seroprevalence of Toxoplasmosis and associated risk factors in HIV-positive pregnant women attending the University of Abuja Teaching Hospital, Abuja, Northcentral Nigeria. Material and methods. This was a hospital-based cross-sectional study. A total of 160 HIV seropositive pregnant women were recruited. Blood samples were collected and tested for anti-T. gondii IgM and IgG using Enzyme Linked Immunosorbent Assay (ELISA). Structured questionnaires were used to collate the sociodemographic variables of participants. Results. Out of the 160 of HIV seropositive pregnant women, the seroprevalence anti-T. gondii IgG and IgM were 29.4% and 4.4%, respectively. There was no significant association between anti-T. gondii and all sociodemographic variables studied (p&gt;0.05). Conclusion. The overall result of this study revealed that the majority of pregnant women were exposed to toxoplasmosis much earlier in life. Hence, these findings will assist obstetricians and gynecologists in the early diagnosis and management of Toxoplasma gondii infection in pregnant women, especially HIV coinfected ones with IgM seropositivity.

Aetiological Pattern of Vulvovaginal Infections in Asymptomatic and Symptomatic HIV Seropositive Women on Antiretroviral Therapy

Introduction: Human Immunodeficiency Virus (HIV) causes severe public health problems. Despite the use of Highly Active Antiretroviral Therapy (HAART), opportunistic infections remain a serious problem in HIV infection. HIV seropositive women are at a higher risk of acquiring Vulvovaginal Infections (VVI), compared to their HIV seronegative counterparts. Also, the large untreated asymptomatic populations remain a source for transmitting agent. Aim: To identify the occurrence of vaginitis in symptomatic and asymptomatic HIV seropositive women. Materials and Methods: HIV seropositive female patients (60 symptomatic and 60 asymptomatic for vulvovaginitis) in the reproductive age group of 18-60 years were screened for their vaginal flora in a tertiary care hospital in East Delhi, India. Wet mount, Gram stain, and culture were performed to screen the samples for vaginitis. Asymptomatic samples were processed to check for asymptomatic VVI. Nugent and Amsel’s score were calculated for Bacterial Vaginitis (BV), and Donders classification was used for Aerobic Vaginitis (AV). Sabouraud’s Dextrose Agar (SDA) was used for fungal cultures, and Fluconazole and Voriconazole sensitivity was tested. The descriptive analysis of compiled data with Chi-square tests where applicable to compare differences between proportions was done. Results: As per the Nugent's score, 90% of symptomatic and 86.66% asymptomatic HIV reactive females had BV. Nugent scoring was found to be a better diagnostic criterion for BV. AV was observed in 33.33% asymptomatic patients. Candida albicans (C.albicans)was the most common agent isolated from 68.75% of Vulvovaginal Candidiasis (VVC) cases. Dual infection of BV and Candidiasis was reported to be 18.33% in symptomatic and 15% in asymptomatic HIV seropositive females. Conclusion: In the present study, despite Antiretroviral Therapy (ART), attendees manifested significantly with BV infection in both groups. VVC due to C. albicans was also predominant in both groups. Co-infection with BV and VVC was the highlight of this study as dual infections of BV and AV remain under-diagnosed as per Sexually Transmitted Infection (STI) syndromic management protocols. The clinicians need to identify AV as a separate entity as treatment modalities are essentially different.

Periodontal health status among HIV-seropositive pregnant women.

Routine oral health care is essential for those living with HIV (human immunodeficiency virus) infection, especially in pregnant women. Hormonal changes during pregnancy, immunosupression in HIV along with bacterial load in periodontal infections strongly influence the pregnancy outcomes. The aim of this study was to evaluate the periodontal health status in HIV seropositive pregnant women in Andhra Pradesh, India. This study includes a sample of 90 divided into three groups; HIV seropositive pregnant women (group PH; n = 30), HIV seropositive nonpregnant women (group H; n = 30), and healthy pregnant women without HIV infection (group P; n = 30). Clinical examination includes the recording of probing depths (PD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and periodontal screening and recording index (PSR) were assessed in three groups. Statistical analysis was done by Mann-Whitney U-test and Wilcoxon paired test using the software SPSS version 17. Clinical parameters do not show any significant variation between the three groups. But slightly higher mean PD and CAL levels was observed in HIV seropositive pregnant and nonpregnant women compared with healthy pregnant women without HIV infection. About 13% of severe gingivitis cases were observed in HIV seropositive pregnant group compared with 6% in HIV seropositive and 3% in healthy pregnant group. Presence of slightly higher percentage of severe gingivitis in HIV seropositive pregnant women strengthens the fact of extra need for preventive oral health services during the prenatal period and provides recommendations for promoting maternal oral health in regional antiretroviral therapy centers in India.

Correlation of Cervical Squamous Intraepithelial Lesions with Human Papillomavirus in Women Infected with the Human Immunodeficiency Virus

The human papillomavirus (HPV) is the major etiologic agent in the development of cervical cancer with known risk factors like immunosuppression. The natural history of HPV infection is altered in persons infected with the human immunodeficiency virus (HIV). The persistent HPV infection increases their risk of having cervical squamous intraepithelial lesions (SILs). This study emphasizes on prevalence of high-risk human papillomavirus (HR-HPV) and correlation with cervical smears cytology in HIV-positive women regardless of treatment. A cross-sectional observational study was conducted at a tertiary care hospital over a period of 2 years. The study group is comprised of HIV seropositive women attending antiretroviral treatment center. CD4 cell counts were taken from the records available, and cervical samples were taken for cytological analysis and HR-HPV testing. Statistical analysis was done using the software Epi 6 Info, and p value was calculated by Chi-square test and Fisher’s exact 2-tailed test for associations of abnormal cytology and to determine risk factors for abnormal cytology. The median age of the 100 participants was 33.34 years. Low-grade squamous intraepithelial neoplasms (LSILs), high-grade squamous intraepithelial neoplasms, atypical squamous cells of uncertain significance and atypical glandular cells were the precancerous lesions found. Prevalence of HR-HPV in HIV-positive women was found to be 35% among women with abnormal smears. A strong correlation between SILs and HR-HPV with p value of < 0.05 was found. A strong statistical correlation was also seen in between low CD4 count to that of detection of HR-HPV along with LSIL. A strong correlation between cervical SILs and HR-HPV in our study suggests that routine screening of cervical cytology by PAP smear should include HPV subtype identification in HIV-positive women to pick up cases which are likely to progress to invasive carcinoma.

Cervical cancer incidence after up to 20 years of observation among women with HIV.

To estimate the incidence of invasive cervical cancer (ICC) across up to 21 years of follow-up among women with human immunodeficiency virus (HIV) and to compare it to that among HIV-uninfected women, we reviewed ICC diagnoses from a 20-year multi-site U.S. cohort study of HIV infected and uninfected women who had Pap testing every 6 months. Incidence rates were calculated and compared to those in HIV-negative women. Incidence ratios standardized to age-, sex-, race-, and calendar-year specific population rates were calculated. After a median follow-up of 12.3 years, four ICCs were confirmed in HIV seropositive women, only one in the last 10 years of observation, and none in seronegative women. The ICC incidence rate did not differ significantly by HIV status (HIV seronegative: 0/100,000 person-years vs. HIV seropositive: 19.5/100,000 person-years; p = 0.53). The standardized incidence ratio for the HIV-infected WIHS participants was 3.31 (95% CI: 0.90, 8.47; p = 0.07). Although marginally more common in women without HIV, for those with HIV in a prevention program, ICC does not emerge as a major threat as women age.

Multitype Infections With Human Papillomavirus: Impact of Human Immunodeficiency Virus Coinfection.

Human immunodeficiency virus (HIV) infection predisposes women to genital coinfection with human papillomaviruses (HPVs). Concurrent infection with multiple HPV types has been documented, but its frequency, correlates, and impact on development of precancer are poorly defined in HIV-seropositive women. Human immunodeficiency virus-seropositive women and -seronegative comparison women were enrolled in a cohort study and followed every 6 months from 1994 to 2006. Cervicovaginal lavage samples were tested for HPV types using polymerase chain reaction amplification with MY09/MY11 consensus primers followed by hybridization with consensus and HPV type-specific probes. Analyses were performed using generalized estimating equations. Multitype HPV infections were found in 594 (23%) of 2543 HIV-seropositive women and 49 (5%) of 895 HIV-seronegative women (P < 0.0001). Compared with HPV uninfected women, those with multiple concurrent HPV infections were more likely to be younger, nonwhite, and current smokers, with lower CD4 counts and HIV RNA levels. The average proportion of women with multitype HPV infections across visits was 21% in HIV-seropositive women and 3% in HIV-seronegative women (P <0.0001). Compared with infection with 1 oncogenic HPV type, multitype concurrent infection with at least 1 other HPV type at baseline did not measurably increase the risk of ever having cervical intraepithelial neoplasia 3+ detected during follow-up (odds ratio, 0.80; 95% confidence interval, 0.32-2.03, P = 0.65). Concurrent multitype HPV infection is common in HIV-seropositive women and frequency rises as CD4 count declines, but multitype infection does not increase precancer risk.

Changes in Serum Transaminases with Haart Administration in Women of Reproductive Age in Benin, Nigeria

This study is aimed at establishing the effect of highly active antiretroviral therapy (HAART) on the Aspartate Transaminase (AST) and Alanine Transaminase (ALT)of human immunodeficiency virus (HIV) seropositive reproductive aged women both in the follicular and luteal phases of their menstrual cycles, using serum. A hundred women aged between 18-40 years (mean=29years) were considered with fifty seronegative women of same age group as controls. The study was prospective and carried out at the University of Benin Teaching Hospital (UBTH), a tertiary institution that has bed compliment of over 700 patients and serves as a referral center for many states in the country of Nigeria. The subjects were recruited before the commencement of HAART and monitored for nine months at three months interval after the initiation of therapy. The transaminases were measured in both the follicular and luteal phases of their menstrual cycle using their serum. Infection by HIV was observed to have led to significant elevations in ASTin both the follicular and luteal phases while the ALT was significantly elevated in the follicular phase and decreased in the luteal phase. With HAART administration, significant decreases were observed in all phases from the third month to the end of study. HAART lowered the AST and ALT which were elevated by HIV infection. HAART led to a significant decrease in the levels of AST and ALT which were elevated by HIV infection against hepatotoxicity as suggested by some researches showing that the sex hormones might have great influence on the effect of HAART. Keywords: Aspartate Transaminase (AST), Alanine Transaminase (ALT), HIV, Follicular phase, Luteal phase

Effect of antiretroviral drugs on prolactin in HIV infected pregnant women

The world has finally settled living with Human immunodeficiency Virus (HIV) with no cure discovered so far. Yong people with HIV infection under HIV management drugs get married and eventually end up being pregnant and bearing babies. The need therefore to investigate the effect of HIV infection and antiretroviral drugs on body chemistry especially the hormones concerned with pregnancy and lactation cannot be over emphasized as this is important to intervene when necessary for the overall benefit for the mother and child. We investigated the effect of anti-retroviral drugs and human immune deficiency virus (HIV) infection on prolactin production and stimulation in HIV-infected pregnant women. A total of 120 subjects participated in the study. Sixty (group 1) of these subjects were HIV seropositive pregnant women who commenced treatment with zidovudine in combination with lamivudine, that is highly anti-retroviral therapy (HAART) at 2nd trimester. The 2nd group made up of 60 HIV seronegative pregnant women who received no drug and as control to the study. The blood samples of both groups were collected at the beginning of the second and at the end of the third trimesters. For group 1 (seropositive pregnant women), the blood collection was done just before commencingthe HAART treatment. The prolactin level of HIV seropositive pregnant women were significantly (P &lt; 0.05) lower than the HIV seronegative pregnant women at the 2nd trimester. Also, the prolactin level of HIV seropositive pregnant women at 2nd trimester was not significantly increased (P&gt; 0.05) compared with third trimester level. The reverse was the case with HIV seronegative pregnant women where prolactin level of 3rdtrimester was significantly increased when compared with 2nd trimester. HIV infection has prolactin suppressive effect on pregnant women and HAART treatment did not significantly raise prolactin level.Keywords: Prolactin, pregnancy, HIV, highly active retroviral therapy (HAART).

The epidemiology of HIV seropositive malaria infected pregnant women in Akure Metropolis, Southwestern Nigeria

Background: HIV increases the risks of malaria in pregnant women, while maternal human immunodeficiency virus (HIV) viral load also facilitates perinatal transmission to neonates. Malaria and HIV coinfection has been shown to exacerbate adverse pregnancy complications. Our study was designed to determine the HIV prevalence of pregnant women at an antenatal clinic in Akure in southwestern Nigeria, investigate the relationship between dual HIV and malaria infection and HIV viral load and CD4+ T cell counts. The study also estimated the risks of adverse pregnancy outcomes in a selected cohort of 74 pregnant women. Materials and Methods: We evaluated the HIV serostatus of 3,225 pregnant women, who attended the antenatal clinic between August 2012 and April 2013. A cohort of 74 pregnant women was selected for the investigation of the relationship between coinfection of HIV and malaria and HIV viral load and CD4+ cell counts. Their HIV status was determined during three trimesters of pregnancy by both HIV-1/2 strips and confirmatory enzyme-linked immunosorbent assay (ELISA) method. Malaria parasitemia was determined by Giemsa-stained thin and thick blood smears. CD4 cell count was by flow cytometry using the CyFlow Counter (Partec, Germany). Viral load estimated by Amplicor HIV-I monitor assay. Results: We found 3.53% prevalence of HIV serostatus among the 3,225 pregnant women who were screened. Forty-four of the 74 subjects were HIV positive and 30 were HIV negative controls. The results show HIV infection among the pregnant women reduced the CD4 cells from a mean of 750 cells/ml for HIV negative women to a mean of 363 cells/ml for HIV seropositive women. Additionally the presence of malaria more than doubled the HIV viral load from a mean of 7,270 ribonucleic acid (RNA) copies/ml for HIV positive women without malaria to 15,148 RNA copies/ml for HIV positive women with malaria. Conclusion: In this study, HIV infection significantly increased risk of acquiring malaria in pregnant women (odds ratio (OR) = 2.27). Dual HIV/malaria infections exacerbated adverse pregnancy outcomes

Clinical and hepatic evaluation in adult dengue patients: a prospective two-month cohort study

To analyze the liver dysfunction and evolution of signs and symptoms in adult dengue patients during a two-month follow-up period. A prospective cohort study was conducted in Campos dos Goytacazes, Rio de Janeiro, Brazil, from January to July, 2008. The evolution of laboratory and clinical manifestations of 90 adult dengue patients was evaluated in five scheduled visits within a two-month follow-up period. Twenty controls were enrolled for the analysis of liver function. Patients with hepatitis B, hepatitis C, those known to be human immunodeficiency virus (HIV) seropositive and pregnant women were excluded from the study. At the end of the second month following diagnosis, we observed that symptoms persisted in 33.3% (30/90) of dengue patients. We also observed that, 57.7% (15/26) of the symptoms persisted at the end of the second month. The most persistent symptoms were arthralgia, fatigue, weakness, adynamia, anorexia, taste alteration, and hair loss. Prior dengue virus (DENV) infection did not predispose patients to a longer duration of symptoms. Among hepatic functions, transaminases had the most remarkable elevation and in some cases remained elevated up to the second month after the disease onset. Alanine aminotransferase (ALT) levels overcame aspartate aminotransferase (AST) during the convalescent period. Male patients were more severely affected than females. Dengue fever may present a wide number of symptoms and elevated liver transaminases at the end of the second month.

Racial/Ethnic Differences in Spontaneous HCV Clearance in HIV Infected and Uninfected Women

Among individuals without human immunodeficiency virus (HIV), African Americans have lower spontaneous clearance of hepatitis C virus (HCV) than Caucasians, and women have higher clearance than men. Few studies report racial/ethnic differences in acute HCV in HIV infected, or Hispanic women. We examined racial/ethnic differences in spontaneous HCV clearance in a population of HCV mono- and co-infected women. We conducted a cross sectional study of HCV seropositive women (897 HIV infected and 168 HIV uninfected) followed in the US multicenter, NIH-funded Women's Interagency HIV Study (WIHS), to determine the association of race/ethnicity with spontaneous HCV clearance, as defined by undetectable HCV RNA at study entry. Among HIV and HCV seropositive women, 18.7 % were HCV RNA negative, 60.9 % were African American, 19.3 % Hispanic and 17.7 % Caucasian. HIV infected African American women were less likely to spontaneously clear HCV than Hispanic (OR 0.59, 95 % CI 0.38-0.93, p = 0.022) or Caucasian women (OR 0.57, 95 % CI 0.36-0.93, p = 0.023). Among HIV uninfected women, African Americans had less HCV clearance than Hispanics (OR 0.18, 95 % CI 0.07-0.48, p = 0.001) or Caucasians (OR 0.26, 95 % CI 0.09-0.79, p = 0.017). There were no significant differences in HCV clearance between Hispanics and Caucasians, among either HIV infected (OR 0.97, 95 % CI 0.57-1.66, p = 0.91) or uninfected (OR 1.45, 95 % CI 0.56-3.8, p = 0.45) women. African Americans were less likely to spontaneously clear HCV than Hispanics or Caucasians, regardless of HIV status. No significant differences in spontaneous HCV clearance were observed between Caucasian and Hispanic women. Future studies incorporating IL28B genotype may further explain these observed racial/ethnic differences in spontaneous HCV clearance.

Epstein Barr virus detection in cervical samples of women living with human immunodeficiency virus

Epstein Barr virus (EBV) is transmitted commonly by saliva, but it has been found in genital secretions, which suggests sexual transmission and led researchers to connect EBV and cervical neoplasia. People living with human immunodeficiency virus (HIV) are reported to be at high risk of acquiring genital infections and cervical lesions. To verify the presence of EBV in the genital tract and/or it could affect cervical changes, we analyzed cervical smears from 85 HIV seropositive women for EBV DNA determination. EBV was only detected in two (2.3%) samples. The present study provides neither evidence for EBV as sexually transmitted infection nor discards this possibility.