Human Immunodeficiency Virus Subjects Research Articles

Benzyl-2-Acetamido-2-Deoxy-α-d-Galactopyranoside Increases Human Immunodeficiency Virus Replication and Viral Outgrowth Efficacy In Vitro.

Glycosylation of host and viral proteins is an important posttranslational modification needed to ensure correct function of glycoproteins. For this reason, we asked whether inhibition of O-glycosylation during human immunodeficiency virus (HIV) in vitro replication could affect HIV infectivity and replication rates. We used benzyl-2-acetamido-2-deoxy-α-d-galactopyranoside (BAGN), a compound that has been widely used to inhibit O-glycosylation in several cell lines. Pretreatment and culture of PHA-blast target cells with BAGN increased the percentage of HIV-infected cells (7.6-fold, p = 0.0115), the per-cell amount of HIV p24 protein (1.3-fold, p = 0.2475), and the viral particles in culture supernatants (7.1-fold, p = 0.0029) compared to BAGN-free cultures. Initiating infection with virus previously grown in the presence of BAGN further increased percentage of infected cells (30-fold, p < 0.0001), intracellular p24 (1.5-fold, p = 0.0433), and secreted viral particles (74-fold, p < 0.0001). BAGN-treated target cells showed less CD25 and CCR5 expression, but increased HLA-DR surface expression, which positively correlated with the number of infected cells. Importantly, BAGN improved viral outgrowth kinetics in 66% of the samples tested, including samples from HIV controllers and subjects in whom no virus could be expanded in the absence of BAGN. Sequencing of the isolated virus indicated no skewing of viral quasi-species populations when compared to BAGN-free culture conditions. BAGN also increased virus production in the ACH2 latency model when used together with latency-reversing agents. Taken together, our results identify BAGN treatment as a simple strategy to improve viral outgrowth in vitro and may provide novel insights into host restriction mechanisms and O-glycosylation-related therapeutic targets for HIV control strategies.

Comparison of Interferon-γ Release Assays and the Tuberculin Skin Test for Diagnosis of Tuberculosis in Human Immunodeficiency Virus: A Systematic Review.

BackgroundIt remains uncertain if interferon-γ release assays (IGRAs) are superior to the tuberculin skin test (TST) for the diagnosis of active tuberculosis (TB) or latent tuberculosis infection (LTBI) in immunosuppressed populations including people with human immunodeficiency virus (HIV) infection. The purpose of this study was to systematically review the performance of IGRAs and the TST in people with HIV with active TB or LTBI in low and high prevalence TB countries.MethodsWe searched the MEDLINE database from 1966 through to January 2017 for studies that compared results of the TST with either the commercial QuantiFERON-TB Gold in Tube (QFTGT) assay or previous assay versions, the T-SPOT.TB assay or in-house IGRAs. Data were summarized by TB prevalence. Tests for concordance and differences in proportions were undertaken as appropriate. The variation in study methodology was appraised.ResultsThirty-two studies including 4,856 HIV subjects met the search criteria. Fourteen studies compared the tests in subjects with LTBI in low TB prevalence settings. The QFTGT had a similar rate of reactivity to the TST, although the first-generation version of that assay was reactive more commonly. IGRAs were more frequently positive than the TST in HIV infected subjects with active TB. There was considerable study methodology and population heterogeneity, and generally low concordance between tests. Both the TST and IGRAs were affected by CD4 T-cell immunodeficiency.ConclusionOur review of comparative data does not provide robust evidence to support the assertion that the IGRAs are superior to the TST when used in HIV infected subjects to diagnose either active TB or LTBI.

Electrocardiographic abnormalities in treatment-naïve HIV subjects in south-east Nigeria.

SummaryBackground:Cardiac complications of human immunodeficiency virus (HIV) infection are important causes of morbidity and mortality. We set out to determine the electrocardiographic (ECG) abnormalities in treatment-naïve HIV-positive patients in Enugu, south-east Nigeria.Methods:This was a cross-sectional study involving 250 HIV-positive and 200 HIV-negative subjects. Demographic and anthropometric data, relevant investigations and ECG results were compared between the groups.Results:An abnormal ECG was present in 70% of the HIV-positive patients, sinus bradycardia in 64%, QTC prolongation in 48%, T-wave inversion in 21.6%, Wolf–Parkinson– White syndrome in 0.8%, abnormal P waves in 12.8%, 1st degree heart block in 2.4%, ST depression in 30%, and left-axis deviation in 1.6%. Underweight was associated with ECG abnormalities (p = 0.001). The HIV-positive patients had more ECG abnormalities than the HIV-negative subjects (p = 0.001).Conclusion:Electrocardiographic abnormalities were common in treatment-naïve HIV-positive patients in Enugu, Nigeria. The 70% prevalence of ECG abnormalities in treatment-naïve HIV-positive patients was high. There is a need to evaluate HIV-positive patients at onset for cardiac and non-cardiac abnormalities detectable by ECG.

Urine osmolality in treatment-naïve HIV-positive subjects in Southeast Nigeria.

Urine osmolality varies over a wide range of values in a healthy state. Dilute urine or concentrated urine may be observed in many environmental, physiologic, and disease conditions. Urine osmolality is not commonly evaluated in routine clinical practice and in human immunodeficiency virus (HIV) subjects. The factors that influence urine osmolality have not been completely identified. The aim of this study was to evaluate urine osmolality in treatment-naïve HIV subjects and to identify the factors that may influence dilute and concentrated urine in this group of patients. This was a cross-sectional study of treatment-naive HIV subjects conducted in Federal Medical Centre (FMC), Owerri, Nigeria. Demographic and anthropometric data were obtained. Urine osmolality and other relevant investigations were conducted. Normal urine osmolality was defined as 24-h urine osmolality (24 HUOsm) 300-750 mOsm/kgH2O, dilute urine as 24 HUOsm 2O and concentrated urine as 24 HUOsm> 750 mOsm/kgH2O. The association between the variables and urine osmolality and the strength of variables to predict dilute urine and concentrated urine were determined. The mean 24HUOsm was 564 ± 501 mOsm/kgH2O and the mean spot urine osmolality (SUOsm) 464 ± 271 mOsm/kgH2O. Normal urine osmolality was observed in 29.6%, dilute urine in 64.5%, and concentrated urine in 5.9% of the HIV subjects. There was a significant association between urine osmolality and body mass index (BMI), creatinine clearance, as well as serum cholesterol level. Only high-density lipoprotein cholesterol (HDL) predicted dilute urine, whereas BMI, spot urine protein, 24-h urine protein, spot urine creatinine, serum HDL, and CD4 cell count predicted concentrated urine. The prevalence of dilute urine was high among the treatment-naïve HIV subjects. Abnormalities of serum lipids, renal function, and weight were common in treatment-naïve HIV subjects who had dilute urine. There is a need for clinicians to routinely assess urine osmolality and further diagnose for dyslipidemia, renal function impairment, and abnormal weight in HIV subjects at the early stage of the infection.

Dyslipidemia in people living with HIV-AIDS in a tertiary hospital in South-East Nigeria.

IntroductionAcross the globe, human immunodeficiency virus (HIV) infection is a healthcare problem. Dyslipidemia, a cardiovascular risk factor, is known to occur with the progression of HIV infection. The factors which influence dyslipidemia in HIV subjects have not been completely identified. The aim of this study was to evaluate serum lipids and identify the factors which might influence dyslipidemia in treatment-naïve HIV subjects in Owerri, Nigeria.MethodsThis was a cross-sectional study of treatment-naïve HIV subjects. Anthropometric and demographic data were collected. Serum LDL serum cholesterol, serum high density lipoprotein cholesterol, serum triglyceride, spot urine creatinine, spot urine osmolality, spot urine protein, serum creatinine, 24-hour urine protein, 24-hour urine osmolality, 24-hour urine creatinine, creatinine clearance and hemoglobin were conducted. The variables were compared between those who have dyslipidemia and those who have no dyslipidemia.ResultsThe mean age of the subjects was 39 ± 11 years. Females constituted 72.0% and males 28.0%. Elevated serum LDL was present in 17.6%, elevated serum total cholesterol in 11.4%, elevated serum triglyceride in 9.9% and low serum HDL in 34.4% of the subjects. There was significant association between dyslipidemia and CD4 cells count, as well as anemia. There was no significant association between dyslipidemia and urine protein, urine creatinine, urine osmolality, creatinine clearance, as well as 24-hour urine volume.ConclusionThe prevalence of dyslipidemia was high in the study subjects. Abnormal CD4 cells count and anemia were common in treatment-naïve HIV subjects who have dyslipidemia.

Variable Influencing Parameters of Different Levels of Immunosuppression in HAART-naive HIV Subjects in Nigeria

Background and Objectives: Varying degrees of immunosuppression may be observed in human immunodeficiency virus (HIV) infected subjects. This study sought to evaluate the factors which might influence different levels of immunosuppression in this group of subjects. Methodology: Immunosuppression, defined as CD4<500 cells/ml, was evaluated in treatment-naive HIV subjects. Body mass index (BMI), 24 h urine creatinine (24HUCr), 24 h urine protein (24HUP), creatinine clearance (ClCr), hemoglobin (Hb) and CD4 cells count were determined and the data compared among the subjects who have different levels of immunosuppression, defined here as mild for CD4 350-499 cells/ml, moderate for CD4 200-349 cells/ml and severe for CD4<200 cells/ml. Results: CD4 cells count 200-349/ml was prevalent in 31.3%, CD4 350-499/ml in 25.4% and CD4 ≥ 500 cells/ml in 122(31.0%) of the HIV subjects. Immunosuppression was significantly associated with BMI (df=9, p=0.008), 24HUCr (df=6, p=0.019) and anemia (df=9, p<0.001). None of these three variables, in addition to 24HUP, was a predictor of moderate immunosuppression (CD4 cells count 200-349/ml). However, BMI, ClCr, 24HUP and Hb were predictors of mild immunosuppression (CD4 350-499 cells/ml) (p=0.006, p=0.008, p=0.026 and p=0.003 respectively). Conclusion: Variable levels of immunosuppression were prevalent in this study. Anemia, abnormal weight and renal damage were common but variable in subjects who have different levels of immunosuppression in the early stage of HIV infection.

Factors of Low CD4 Cells Count in Treatment-naïve HIV Subjects in Southeast Nigeria

Background and objectives: Human immunodeficiency virus (HIV) infection is a global healthcare problem. Low CD4 cells count, an index of immunosuppression, is associated with escalating activity and progression of HIV infection. The factors which influence low CD4 cells count have not been completely identified nor are they evaluated in routine clinical practice. The aim of this study was to determine the prevalence of low CD4 cells count and to evaluate the factors which might influence immunosuppression in treatment-naive HIV subjects in Southeast Nigeria. Methodology: This was a cross-sectional study involving treatment-naive HIV subjects. Anthropometric and demographic data were obtained and CD4 cells count and other relevant investigations performed. The data were compared between those who have low CD4 cells count, defined, here, as CD4 <200 cells/ml, and those with CD4 ≥ 200 cells/ml. Potential risk factors of low CD4 cells count were determined. Results: The mean age of the subjects was 39+11 years. Females were made up 283 (72.0%) and males 110 (28.0%). The median value of the CD4 cells count was 391. Low CD4 cells count was prevalent in 49 (12.5%) of the subjects. There was significant association between CD4 cells count and body mass index (df=2, p=0.017), as well as serum low density lipoprotein cholesterol (df=1, p=0.027) and anemia (df=3, p=0.025). Significant, but poor, correlation was observed between CD4 cells count and 24 h urine protein (r=-0.117, p=0.023), creatinine clearance (r=-0.122, p=0.018), as well as hemoglobin (r=0.224, p<0.001). Creatinine clearance was a predictor of low CD4 cells count, p=0.001. Conclusion: The prevalence of low CD4 cells count was high in this study. Abnormal weight, dyslipidemia and proteinuric renal damage were common among treatment-naive subjects who have low CD4 cells count.

The Role of Cancer Biomarkers in HIV Infected Hosts.

A higher incidence of cancer has been observed in Human Immunodeficiency Virus (HIV) infected individuals as compared with healthy people of the same age. A complex relationship between HIV-induced immune suppression, chronic antigenic stimulation, and oncogenic virus co-infections may promote carcinogenesis and increase the risk of developing tumors in these patients. Cancers in HIV subjects include the AIDS-defining malignancies (ADMs) and other non-AIDS-defining malignancies (NADMs). Antiretroviral therapy has reduced the incidence of ADMs whereas a concurrent increase of NADMs was observed in the last years. Biomarkers are measurable parameters, characterizing normal or pathogenic processes, which could provide a high potential for risk evaluation and diagnosis of patients. Therefore, the early detection of cancer biomarkers in HIV-positive subjects would be useful to identify patients at most risk of tumor disease development. This review will focus principally on the risk assessment and diagnostic role of several biomarkers of malignancy in HIV patients including cellular and viral biomarkers, cytokines, immune activation molecules and genetic polymorphisms.

Prevalence and Associated Factors of Anemia in Treatment-naïve HIV-positive Subjects in Southeast Nigeria

Background and Objectives: Anemia is an issue in human immunodeficiency virus (HIV) infection. This study was to determine the prevalence and associated risk factors of anemia in highly active anti-retroviral therapy (HAART)-naive, HIV-positive subjects in Owerri, Southeast Nigeria. Methodology: This was a cross-sectional study of HAART-naive HIV-positive subjects. Anthropometric and demographic data were collected. Hemoglobin (Hb) and other relevant investigations were performed. Anemia was defined, according to World Health Organization criteria, as Hb <13.0g/dl in males and Hb <12.0g/dl in females. Association of variables with anemia and the strength of variables to predict anemia were determined. Results: Mean Hb was 11.3±1.7g/dl in males and 11.1±1.9g/dl in females. Hb<13.0g/dl was present in 66.4% of males, while Hb<12.0g/dl was present in 67.8% of females. Overall, Hb≥12.0g/dl was present in 128(32.6%), Hb<12.0g/dl in 252(67.4%), Hb 11.0-12.0g/dl in 177(45.0%), Hb 8.0-10.9g/dl in 82(20.9%) and Hb<8.0g/dl in 6(1.5%) of the HIV subjects. Body mass index (BMI) and cluster of differentiation 4 (CD4) cells count predicted hemoglobin, while underweight, BMI, CD4 cells count <200/ml, spot urine protein (SUP) and 24-hour urine protein (24HUP) predicted anemia in HIV-positive subjects. Conclusion: The prevalence of anemia was high (67.4%) in HAART-naive HIV-positive subjects. BMI and CD4 cells count were predictors of hemoglobin in HIV-positive subjects. CD4 cells count <200, underweight, BMI, 24HUP and SUP were predictors of anemia in HAART-naive HIV-positive subjects. Abnormalities of weight changes and renal function were common in HAART-naive HIV-positive subjects who were anemic in Owerri, Southeast Nigeria. Anemic HAART-naive HIV-positive subjects should be evaluated at the early stages of the infection for underweight and renal damage.

Early Treatment in HIV Patients: A Cost-Utility Analysis from the Italian Perspective.

Highly active antiretroviral therapy (HAART) has modified the clinical course of human immunodeficiency virus (HIV) infection, reducing the rate of disease progression, the incidence of opportunistic infections and mortality. Several recent studies show early antiretroviral therapy reduces the risk of AIDS and HIV-related disease. The aim of this study was to perform an economic analysis to estimate the cost-utility of early antiretroviral therapy in Italy for managing HIV-infected patients. The incremental cost-utility analysis was carried out to quantify the benefits of the early-treatment approach in HIV subjects. A Markov simulation model including direct costs and health outcomes was developed from a third-party (Italian National Healthcare Service) payer's perspective for four CD4 strata. 5000 Monte Carlo simulations were performed on two distinct scenarios: Standard of care (SoC) in which 30% of patients started HAART with a CD4 count ≥500 cells/mm(3) versus the early-treatment scenario (ETS), where the number of patients starting HAART with a CD4 count ≥500 cells/mm(3) increased to 70%. A systematic literature review was carried out to identify epidemiological and economic data, which were subsequently used to inform the model. In addition, a one-way probabilistic sensitivity analysis was performed in order to measure the relationship between the effectiveness of the treatments and the number of patients to undergo early treatment. The model shows, in terms of the incremental cost-effectiveness ratio (ICER) per quality-adjusted life years (QALY) gained, that early treatment appeared to be the most cost-effective option compared to SoC (ICER = €13,625) over a time horizon of 10 years. The cost effectiveness of ETS is more sustainable as it extends the time horizon analysis (ICER = €7526 per QALY to 20 years and €8382 per QALY to 30 years). The one-way sensitivity analysis on the main variables confirmed the robustness of the model for the early-treatment approach. Our model represents a tool for policy makers and health-care professionals to provide information on the cost effectiveness of the early-treatment approach in HIV-infected patients in Italy. Starting HAART earlier keeps HIV-infected patients in better health and reduces the incidence of AIDS- and non-AIDS-related events, generating a gain in terms of both patients' health and correct resource allocation.

Effects of HIV, Immune Deficiency, and Confounding on the Distal Gut Microbiota

Human immunodeficiency virus (HIV) infection progressively destroys CD4 + mononuclear cells leading to profound cellular immune deficiency that manifests as life threatening opportunistic infections and malignancies, i.e., the acquired immune deficiency syndrome (AIDS). The gut mucosa-associated lymphoid tissue (MALT, e.g., Peyer's patches) is a major locus of CD4 + cells. HIV's asymptomatic and insidious destruction of these cells compromises the integrity of the gut mucosa, allowing translocation (leakage) of microbes and other luminal contents into the circulation (Brenchley et al., 2004). Microbial translocation induces subtle but sustained and widespread immune activation, which is a major contributor to HIV's pathogenesis (Brenchley et al., 2006).

Urine creatinine in treatment-naïve HIV subjects in eastern Nigeria.

IntroductionHuman immunodeficiency virus (HIV) infection is a global healthcare problem. Some diseases and physiological states may be altered in HIV-infected individuals. Our objective was to evaluate urine creatinine and factors that influence urine creatinine in treatment-naïve HIV subjects in Nigeria.MethodsThis was a cross-sectional study involving treatment-naïve HIV subjects in a tertiary hospital in Nigeria. Creatinine in spot and 24-hour urine samples and other relevant investigations were performed. Low urine creatinine or dilute urine was defined as 24-hour urine creatinine (24HUCr) <300mg, normal urine creatinine as 24HUCr 300-3000mg and high urine creatinine or concentrated urine as 24HUCr>3000mg.Theassociation of low urine creatinine and high urine creatinine with potential risk factors was determined.ResultsThe mean spot urine creatinine (SUCr) of the treatment-naïve HIV subjects was 137.21± 98.47(mg/dl), minimum value 13.3mg/dl, maximum value 533.3mg/dl and range of values 520.0mg/dl. The mean 24HUCr was 1507±781mg, minimum value 206mg, maximum value 4849mg and range of values 4643mg. Twenty four-hour urine creatinine<300mg was observed in 2(0.5%) subjects, normal 24HUCr 300-3000mgin 349(93.1%) subjects and 24HUCr>3000mg in 24(6.4%) subjects. There was significant association between 24HUCr and serum low density lipoprotein cholesterol (LDL),serum high density lipoprotein cholesterol (HDL). There was high correlation between 24HUCr>3000mg and 24-hour urine osmolality (24HUOsm) (r=0.95), body mass index (BMI) (r=0.74), CD4 cells count (r=-0.71), serum HDL (r=-0.73).ConclusionThe prevalence of dilute urine and concentrated urine was low. Twenty-four hour urine osmolality. BMI, CD4 cells count and HDL were strong correlates of high urine creatinine. Lipid abnormalities were common in treatment-naïve HIV subjects with high urine creatinine. There is need for clinicians to routinely conduct urine creatinine and further search for abnormalities of serum lipids, weight changes, depressed immunity and anemia in HIV subjects with dilute or concentrated urine in the early stages of the infection.

Prevalence and predictors of chronic kidney disease in newly diagnosed human immunodeficiency virus patients in Owerri, Nigeria.

Human immunodeficiency virus (HIV) infection is a common cause of chronic kidney disease (CKD) in Sub-Saharan Africa. This study aims at identifying the prevalence and predictors of CKD in newly diagnosed HIV patients in Owerri, South East Nigeria. This was a cross-sectional study consisting of 393 newly diagnosed HIV-seropositive subjects and 136 age- and sex-matched seronegative subjects as controls. CKD was defined as 24-hour urine protein (24-HUP) ≥0.3 g and/or glomerular filtration rate (GFR) < 60 ml/min. Subjects were recruited from the HIV clinic and the Medical Outpatient Department of Federal Medical Centre, Owerri. Clinical and anthropometric data were collected. Relevant investigations were performed, including HIV screening and relevant urine and blood investigations. The mean age of the HIV subjects was 38.84 ± 10.65 years. CKD was present in 86 (22.9%) HIV subjects and 11 (8.l %) controls. Low waist circumference (WC), high serum creatinine, high spot urine protein/creatinine ratio (SUPCR), high 24-HUP/creatinine Ratio (24-HUPCR), high 24-HUP/osmolality Ratio (24-HUPOR) predicted CKD in HIV subjects. CKD prevalence is high (22.9%) among newly diagnosed HIV patients in South East Nigeria. The predictors of CKD included WC, serum creatinine, SUPCR, 24-HUPCR, and 24-HUPOR.

Clinical &amp; epidemiological profile of malignancy in HIV a retrospective study

Background: HIV is the etiologic agent of AIDS. HIV infection is associated with various types of opportunistic infections and malignancies. The incidence of malignancies among Human Immunodeficiency Virus (HIV) infected patients is known to be higher than in the general population. The study was aimed to know the profile of malignancy in HIV infected individuals. Methodology: Study was a Retrospective study & data was collected from medical records department using semi structured proforma. 40 HIV subjects diagnosed with malignancy was obtained. Stastical analysis of data was done using Chi square test and Fisher’s exact test. Results: Out of 40 HIV subjects diagnosed with malignancy in our study 62%, were males and 38% were females, 95% were receiving ART, Predominantly the patients were in STAGE 4 and NHL was the most common malignancy in our study. CD4 count has no correlation with the incidence of malignancy. Conclusion: Age and Gender distribution does not affect the type of malignancy. Non AIDS defining malignancies are more prevalent than AIDS defining malignancies. NHL is the commonest type of AIDS defining malignancy. CD4 count and HIV stage does not predict the type of malignancy, immunodeficiency can be a trigger for development of malignancy.

Plasma cholesterol efflux capacity from human THP-1 macrophages is reduced in HIV-infected patients: impact of HAART

The capacity of HDL to remove cholesterol from macrophages is inversely associated with the severity of angiographic coronary artery disease. The effect of human immunodeficiency virus (HIV) infection or its treatment on the ability of HDL particles to stimulate cholesterol efflux from human macrophages has never been studied. We evaluated the capacity of whole plasma and isolated HDL particles from HIV-infected subjects (n = 231) and uninfected controls (n = 200), as well as in a subset of 41 HIV subjects receiving highly active antiretroviral therapy (HAART) to mediate cholesterol efflux from human macrophages. Plasma cholesterol efflux capacity was reduced (-12%; P = 0.001) in HIV patients as compared with controls. HIV infection reduced by 27% (P < 0.05) the capacity of HDL subfractions to promote cholesterol efflux from macrophages. We observed a reduced ABCA1-dependent efflux capacity of plasma (-27%; P < 0.0001) from HIV-infected subjects as a result of a reduction in the efflux capacity of HDL3 particles. HAART administration restored the capacity of plasma from HIV patients to stimulate cholesterol efflux from human macrophages (9.4%; P = 0.04). During HIV infection, the capacity of whole plasma to remove cholesterol from macrophages is reduced, thus potentially contributing to the increased coronary heart disease in the HIV population. HAART administration restored the removal of cholesterol from macrophages by increasing HDL functionality.

Abstract W P399: Magnetic Resonance Imaging Based Cerebral Blood Flow Changes in Asymptomatic Human Immunodeficiency Virus Infected Subjects

Background: Human Immunodeficiency Virus (HIV) infected individuals are at high risk for ischemic stroke. Magnetic resonance imaging (MRI) method of measurement of cerebral blood flow (CBF) and oxygen extraction fraction (OEF) may help assess the stroke risk in asymptomatic HIV subjects. Objectives: To evaluate MR measured CBF and OEF in treatment naïve asymptomatic HIV+ subjects and HIV- controls. Methods: Treatment naïve asymptomatic HIV+ subjects and age-gender-race matched HIV- controls were assessed for CBF using a pulsed arterial spin labeling (PASL) approach and Oxygen Extraction Fraction (OEF) using MRI T2*-weighted echo-planar imaging (EPI) sequences. All images were acquired using a Siemens 3T MR scanner (Treo, Siemens Medical Systems Inc). Quantitative CBF and OEF measurements were made in the whole-brain, gray matter and white matter and compared between the groups using unpaired t-test. Results: A total of 65 subjects of who, 35 treatment naïve HIV+ subjects (Mean age ± SD=30±7,89% male, 31% white, 49% black and 20% others) and 30 age-gender-race matched HIV- controls (Mean age± SD= 31±8,93% male, 37% white, 53% black and 10% others) consented to the protocol. HIV+ subjects compared to HIV- controls had significantly higher whole brain CBF (58.0 ± 13.8 ml/100g/min vs. 51.3 ± 9.0 ml/100g/min; p=0.03) and gray matter CBF (72.9 ± 16.2 ml/100g/min vs. 63.9 ± 9.9 ml/100g/min; p=0.01). However, values for whole brain OEF (0.4 ± 0.04) and gray matter OEF (0.4 ± 0.05) were similar for both groups. White matter CBF in HIV+ subjects (41.5 ± 13.1 ml/100g/min) compared to HIV- controls (37.2 ± 9.2 ml/100g/min) was not significantly higher (p=0.16) while white matter OEF (0.4 ± 0.04 HIV+ subjects vs. 0.4 ± 0.03 HIV-controls) showed no changes. Conclusions: The observed increase of whole brain CBF in treatment naïve HIV + subjects compared to HIV- matched controls, without corresponding changes in the OEF appears to be driven by a pronounced significant change in the gray matter compared with the white matter. These changes in CBF without corresponding changes in OEF suggest increase in metabolic activity, and may explain the higher stroke risk in asymptomatic HIV subjects.

Effect of HIV Infection and Antiretroviral Therapy Duration on CD4 Count, Total and Differential White Cell Count

Aims: To assess CD4 counts, total and differential white cell counts in HIV positive patients on antiretroviral treatment (ART) and those not on antiretroviral treatments with varying durations of Original Research Article Okeke et al.; ISRR, 3(1): 14-22, 2015; Article no.ISRR.2015.003 15 infection. Study Design: Case-control study. Place and Duration of Study: Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria from March to August 2013. Methodology: We included 181 subjects; sixty HIV patients on ART with infection duration of 5 – 8 and >8 – 17 years and ART duration of 5 – 8 and >8 – 17 years; sixty HIV patients not on ART with an infection duration of 3 – 6 and >6 – 11years; and sixty-one apparently healthy individuals control. CD4 counts, total and differential white cell counts as well as Human Immunodeficiency virus (HIV) status were determined. Results: CD4 counts was significantly higher in the control compared to the ART and non-ART and lower in HIV duration of 3 – 6 years and >6 – 11 years (P 6 – 11 years both in non-ART subjects (P<.05) TWBC was also higher in female controls than male (P<.05). Conclusion: CD4 count is generally lower in HIV subjects. TWBC is elevated in non-ART, while MXD is higher in ART and non-ART subjects. There is no difference in white cell parameters for ART subjects irrespective of differences in duration of HIV infection and antiretroviral therapy.

Comparison of Spot Urine Protein/Creatinine Ratio, Spot Urine Protein/Osmolality Ratio with Measured 24-Hour Urine Protein in HIV Subjects in Nigeria

Background and Objectives: Urine protein examination is a veritable tool in the management of renal diseases. Proteinuria evaluation from 24-hour urine collection is the gold standard. Prompt urine protein assessment from spot urine sample has become necessary to eliminate inaccuracies inherent in timed urine collection. This study aims at comparing spot urine protein/creatinine ratio (SUPCR) and measured 24-hour urine protein (24 HUP), and also spot urine protein/osmolality ratio (SUPOR) and 24 HUP against measured 24-hour urine protein (24 HUP) for assessment of proteinuria in human immunodeficiency virus (HIV) subjects. Methodology: Three hundred and ninety three HIV subjects from the HIV/AIDS clinic and 136 age- and sexmatched non-HIV subjects as Control. Investigations performed included 24-hour urine protein (24 HUP), spot urine protein (SUP), spot urine creatinine (SUCr), spot urine osmolality (SUOsm), fasting blood sugar (FBS), urinalysis, HIV screening and confirmatory test, electrolyte, urea and creatinine. SUPCR and SUPOR were calculated. Correlation statistics, 2 × 2 contingency table analysis, receiver operator characteristics (ROC) Curve analysis and Bland Altman plots were used to compare SUPCR and 24 HUP, and also SUPOR and 24 HUP in HIV subjects and control. SPSS version 17 and Medcal statistical software were used to analyze the data. P<0.050 was taken as statistically significant. Results: Using the 2 × 2 contingency table in the HIV subjects, the Sensitivity for SUPCR and SUPOR with 24 HUP was 43.4% and 11.5% respectively. Specificity for SUPCR and SUPOR with 24 HUP was 92.9% and 99.2% respectively. The SUPCR had a correlation (r) of 0.734 (p<0.001) with 24 HUP. In addition, SUPOR had a correlation coefficient of 0.417 (p<0.001) with 24 HUP. Using the Bland Altman plots, SUPCR compared with 24HUP the limits of agreement were +0.361 g/day to -0.248 g/day in HIV subjects. In addition for SUPOR the limits of agreements were +0.440 g/day to-0.180 g/day in HIV subjects. The bias was 0.060 g/day and 0.130 g/day for SUPCR and SUPOR respectively. The receiver operating characteristics (ROC) curve showed that SUPCR randomly chosen value of 0.042 mg/mg and SUPOR chosen value of 0.010 mg/dl/mOsm/kg H2O predicted 24 HUP at urinary excretion threshold of 0.150 g. Conclusion: The SUPCR and SUPOR are reliable tests, for quantifying proteinuria in HIV subjects, and should be used in assessment of proteinuria in HIV subjects in Sub Saharan African countries.

Elevated homocysteine levels in human immunodeficiency virus-infected patients under antiretroviral therapy: A meta-analysis.

To evaluate the association between the levels of homocysteine (Hcy), folate, vitamin B12 in human immunodeficiency virus (HIV)-infected patients who were treated with antiretroviral therapy (ART) or not treated with ART. The PubMed and Scielo databases were searched. Eligible studies regarding plasma Hcy level in HIV-infected patients were firstly identified. After careful analysis by two independent researches, the identified articles were included in the review according to two outcomes (1) Hcy, folate and vitamin B12 blood concentration in HIV-infected subjects vs health controls and; (2) Hcy blood concentration in HIV-infected subjects under ART vs not treated with ART. RevMan (version 5.2) was employed for data synthesis. A total of 12 studies were included in outcome 1 (1649 participants, 932 cases and 717 controls). Outcome 1 meta-analysis demonstrated higher plasma Hcy (2.05 µmol/L; 95%CI: 0.10 to 4.00, P < 0.01) and decreased plasma folate concentrations (-2.74 ng/mL; 95%CI: -5.18 to -0.29, P < 0.01) in HIV-infected patients compared to healthy controls. No changes in vitamin B12 plasma concentration were observed between groups. All studies included in the outcome 2 meta-analysis (1167 participants; 404 HIV-infected exposed to ART and 757 HIV-infected non-ART patients) demonstrated higher mean Hcy concentration in subjects HIV-infected under ART compared to non-ART HIV subjects (4.13 µmol/L; 95%CI: 1.34 to 6.92, P < 0.01). This meta-analysis demonstrated that the levels of Hcy and folate, but not vitamin B12, were associated with HIV infection. In addition, Hcy levels were higher in HIV-infected patients who were under ART compared to HIV-infected patients who were not exposed to ART. Our results suggest that hyperhomocysteinemia should be included among the several important metabolic disturbances that are associated with ART in patients with HIV infection.

Serum protein electrophoresis patterns in human immunodeficiency virus-infected individuals not on antiretroviral treatment.

B lymphocyte stimulation is described in human immunodeficiency virus (HIV) infection and results in ongoing immunoglobulin production with abnormal serum protein electrophoresis patterns. We hypothesized that serum protein electrophoresis patterns would be abnormal in untreated HIV subjects and correlate with markers of disease severity. Serum protein electrophoresis was performed on 70 HIV-positive, clinically well treatment-naïve subjects and 42 HIV-negative controls and correlated with markers of disease severity, namely CD4+ counts, viral loads, IgG and albumin. The mean age for both groups was 33 years, and female-to-male ratios were 4:1. All were of Black ethnicity. Mean CD4 counts ± SD for HIV group and controls were 419.5 ± 218.6 and 960.4 ± 378.5 cells/mm(3), respectively. Of the HIV-infected group, 44% showed polyclonal hypergammaglobulinaemia versus 10% of controls (P < 0.01). The HIV group had 27% with an abnormal pattern requiring immunofixation which revealed nine (12.5% of total) had oligoclonal bands, seven (10.3% of total) had polyclonal hypergammaglobulinaemia and three (4% of total) had monoclonal bands. CD4+ counts were lower in those with polyclonal hypergammaglobulinaemia or abnormal serum protein electrophoresis. Interestingly, viral load results showed no statistically significant differences. We found a remarkably high level (53%) of polyclonal hypergammaglobulinaemia in our untreated population compared with uninfected controls (10%). Only 4% of the HIV-positive group had a monoclonal band. Polyclonal hypergammaglobulinaemia correlated significantly with lower CD4+ counts. These results highlight the generalized B cell stimulation in untreated HIV infection. Future longitudinal studies will be important to determine the prognostic value of these findings.