Immunodeficiency Syndrome Patients Research Articles

Assessment of quality of life among human immunodeficiency virus/Acquired immuno deficiency syndrome patients: A study at antiretroviral therapy center at Malda, West Bengal, India

Background: With availability of free of cost antiretroviral therapy (ART) in India, longevity of the disease has improved. However, owing to lifelong treatment, opportunistic infections and ultimate fatal outcome and quality of life (QOL) of human immunodeficiency virus/acquired immuno deficiency syndrome (HIV/AIDS) patients have emerged as a significant medical outcome measure in recent times. Objective: The present study was conducted to assess the QOL and associated factors among HIV/AIDS patients attending Malda Medical College ART Center in Malda, West Bengal. Materials and Methods: A cross-sectional study was conducted from September to December 2017 among 155 patients ≥18 years, attending the ART Center of Malda Medical college. Participants were interviewed using a validated Bengali version of the World Health Organization QOL (WHO-QOL BREF). Median scores were calculated in each domain. Mann–Whitney U-test was used to find associated factors. Results: Majority of the patients perceived their QOL and health as good. Median scores of QOL of patients were maximum in physical (69 [25]) and environmental (63 [19]) domains; minimum in psychological (56 [19]) and social (56 [31]) domains. Current illness significantly affected physical and social domains. Current unemployment significantly affected physical and psychological domains. Married persons had significantly higher scores in social domain. Lesser age and lower socioeconomic status had significantly lower QOL in the environmental domain. Conclusion: The present findings highlight the need for suitable employment opportunities for HIV-infected persons to improve social health. Enhanced sociopsychological supports such as social sensitization, mental health care of patients, and interventions to reduce stigma should be done.

Butyrylcholinesterase Levels on Admission Predict Severity and 12-Month Mortality in Hospitalized AIDS Patients.

Background Butyrylcholinesterase (BChE) is synthesized mainly in the liver and an important marker in many infectious/inflammatory diseases, but its role in acquired immunodeficiency syndrome (AIDS) patients is not clear. We wished to ascertain if BChE level is associated with the progression/prognosis of AIDS patients. Methods BChE levels (in U/L) were measured in 505 patients; <4500 was defined as “low” and ≥4500 as “normal.” Associations between BChE level and CD4 count, WHO stage, body mass index (BMI), C-reactive protein (CRP) level, and duration of hospitalization were assessed. Kaplan–Meier curves and Cox proportional hazards model were used to assess associations between low BChE levels and mortality, after adjustment for age, CD4 count, WHO stage, and laboratory parameters. Results A total of 129 patients (25.5%) had a lower BChE level. BChE was closely associated with CD4 count, WHO stage, CRP level, and BMI (all P < 0.001). Eighty-four patients (16.6%) died in the first year of follow-up. One-year survival was 64.5 ± 4.5% for patients with low BChE and 87.6 ± 1.8% for those with normal BChE (log-rank, P < 0.001). After adjustment for sex, age, BMI, WHO stage, and CD4 count, as well as serum levels of hemoglobin, sodium, and albumin, the hazard ratio was 1.8 (95% confidence interval, 1.0–3.2) for patients with a low BChE compared with those with a normal BChE (P = 0.035). Conclusion BChE level is associated with HIV/AIDS severity and is an independent risk factor for increased mortality in AIDS patients.

Virulence of Mycobacterium avium Subsp. hominissuis Human Isolates in an in vitro Macrophage Infection Model

Mycobacterium avium subsp. hominissuis (MAH) is an environmental opportunistic pathogen for humans and swine worldwide; in humans, the vast majority of MAH infections is due to strains belonging to specific genotypes, such as the internal transcribed spacer (ITS)-sequevars Mav-A and Mav-B that mostly cause pulmonary infections in elderly patients and severe disseminated infections in acquired immunodeficiency syndrome patients, respectively. To test whether the different types of infections in distinct patients' populations might reflect a different virulence of the infecting genotypes, MAH human isolates, genotyped by ITS sequencing and MIRU-VNTR minisatellite analysis, were studied for the capacity to infect and replicate in human macrophages in vitro. Cultures of human peripheral blood mononuclear cells and phagocytic human leukemic cell line THP-1 cells were infected with each MAH isolate and intracellular colony-forming units (CFU) were determined. At 2 h after infection, i.e., immediately after cell entry, the numbers of intracellular bacteria did not differ between Mav-A and Mav-B organisms in both phagocytic cell types. At 5 days, Mav-A organisms, sharing highly related VNTR-MIRU genotypes, yielded numbers of intracellular CFUs significantly higher than Mav-B organisms in both phagocytic cell types. MIRU-VNTR-based minimum spanning tree analysis of the MAH isolates showed a divergent phylogenetic pathway of Mav-A and Mav-B organisms. Mav-A and Mav-B sequevars might have evolved different pathogenetic properties that might account for their association with different human infections.

Study of ocular manifestations in pediatric human immunodeficiency virus according to national acquired immunodeficiency syndrome patients in a tertiary care hospital

Introduction: Ocular involvement in children with HIV AIDS most commonly include allergic conjunctivitis, herpes zoster ophthalmicus,molluscum contagiosum, retinal vasculitis, CMV retinitis and isolated cotton wool spots. Materials and Methods: Non comparative prospective study was conducted at a tertiary care hospital from January 2015 to December 2015. A total of 506 patients of upto 12 years of age, affected with HIV AIDS, attending ART centre of the institute, were thoroughly examined for ocular involvement. Preliminary history which includes blurring of vision , deviation of eyes, night blindness or any other ocular complaints was documented. Detailed ocular examination was done thoroughly. Patient's ART case sheet was also referenced to know about any systemic conditions like tuberculosis, pneumocystis pneumonia, kaposi's sarcoma etc. Patients' most recent CD4 count was also documented. Results: Out of 506 children examined, 140 were found to have ocular involvement (27.6%). Anterior segment findings were found in 14.8% whereas retinal and optic nerve findings were found in 12.45% of patients. Ocular manifestations were also co-related with the CD4 count of the patients which showed that lower CD4 counts is significantly associated with increased ocular involvement. Conclusion: Our study concludes that the most common ocular manifestations in paediatric HIV patients include retinal perivasculitis, allergic conjunctivitis, herpes zoster ophthalmicus and dry eye and also demonstrates that ocular involvement is significantly associated with lower CD4 counts.

Restriction Fragment Length Polymorphism-based Genotyping of Toxoplasma gondii from Autopsy-Proven Cases of Acquired Immunodeficiency Syndrome-associated Cerebral Toxoplasmosis.

Context:Published data on genetic characterization of Toxoplasma gondii (T.gondii) from clinical cases of toxoplasmosis from India is lacking.Aims:The present study was aimed at identifying genetic types of T. gondii in fatal cases of cerebral toxoplasmosis (CT) associated with HIV, from India.Settings and Design:Archived tissues of CT were obtained postmortem from 25 acquired immunodeficiency syndrome patients between 2000 and 2014.Subjects and Methods:Direct amplification of eight different loci, namely, SAG1, 5'-3'SAG2, Alt. SAG2, SAG3, BTUB, GRA6, C22-8, and L358 followed by restriction fragment length polymorphism was used to genotype the parasite.Results:The canonical Types I, II, or III were not found in our study. More than 96% of the cases harbored atypical genotypes–likely recombinants of the canonical types; one case closely corresponded to Type II genotype.Conclusions:Thus, a majority of T. gondii causing CT in South India belonged to a noncanonical lineage. These nonarchetypal genotypes differed from the conventional Types I, II, and III and caused devastating severity in patients with CT in the background of HIV. These results are a step further to deciphering the population genetics of this important zoonotic parasitic infection in Indian patients, information that has thus far been lacking.

Prevalence and factors associated with the use of traditional medicines among human immunodeficiency virus and acquired immunodeficiency syndrome patients in Sokoto, Nigeria.

Background:In resource-scarce settings like Nigeria, access to conventional drugs and antiretroviral therapy (ART) is highly limited, hence the resort to use of traditional herbal medicine by a significant number of people living with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) (PLWHAs). Traditional medicine (TM) continues to provide health coverage for most of the people in developing countries, and it is equally becoming increasingly popular in western countries.Aim:This study aims to present the status and use of TM and determine the factors associated with its use among patients with HIV/AIDS on highly active ART in a tertiary health institution in Sokoto, Northwest Nigeria.Methodology:This was a descriptive, cross-sectional study involving HIV/AIDS patients attending antiretroviral treatment center of the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. The study population comprised PLWHAs attending the ART clinic of the hospital (UDUTH). A total of 271 respondents were recruited into the study and administered a set of pretested structured questionnaire. Ethical approval for this study was obtained from the ethical committee of the teaching hospital.Results:Only 11 (4.2%) of the respondents had used TM before, of whom 9 (5%) were females and 2 (2.7%) were males with P = 0.399. Only one of the respondents had side effects following the use of TM, and the most common reason for the use of TM was as a result of too much weight loss.Conclusion:Although the use of TM among the study participants in Sokoto was low, there is need to educate PLWHAs about the possible risks of interactions following the concurrent use of TM and ART.

Imaging Findings of Common Opportunistic Infections and Malignant Tumors in Acquired Immunodeficiency Syndrome Patients.

The incidence of human immunodeficiency virus (HIV) infection has gradually increased in recent years.HIV mainly destroys the body's immune system,leading to decreased body resistance and thus the development of a variety of opportunistic infections and neoplastic diseases,especially in the digestive system. However,the clinical manifestations,laboratory findings,and physical examination results of these conditions are not specific. Imaging examinations can determine the presence of infection and tumor lesions and the disease scope;furthermore,they are useful tools for biopsy and follow-up evaluation. A better knowledge of the radiological findings of these diseases can enable radiologists to provide more information to patients and clinicians. This article summarize the imaging findings of common opportunistic infections and malignant tumors in acquired immunodeficiency syndrome patients.

Ocular manifestation and their associated factors among HIV/AIDS patients receiving highly active antiretroviral therapy in Southern Ethiopia.

To assess the pattern of ocular manifestation and associated factors among human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients on highly active antiretroviral therapy (HAART) at Hawassa University Referral Hospital, Southern Ethiopia. A cross sectional study was conducted from January 2014 to April 2015. After obtaining informed written consent, 240 adult HIV/AIDS patients on HAART were randomly selected regardless of their ophthalmic symptoms, WHO status or CD4 count. Data were collected using structured questionnaires and ophthalmologic clinical examination. Data were entered and analyzed using SPSS version 20.0 software. The mean duration of HAART was 62.5mo. The prevalence of HIV related ocular manifestation was 14.2%. Seborrheic blepharitis (5%) was the most common ocular manifestation, followed by squamoid conjunctival growth (3.8%). The rate of ocular manifestation was significantly higher among study participants who had CD4+ count <200 cells/µL (AOR=3.83; 95%CI: 1.315-11.153), low duration of HAART (AOR=3.0; 95%CI: 1.305-6.891) and who had primary school education [odds ratio (OR) =2.8; 95%CI: 1.105-7.099]. Prevalence of visual impairment and blindness was 10.9% and 5.8%, respectively. HAART may be the reason for the decline in the prevalence of ocular manifestation in HIV/AIDS patients in the study area. Ophthalmologic screening of HIV/AIDS patients, especially those with CD4 counts of <200/µL cells and in the first five years of HAART follow-up is recommended to reduce visual impairment and/or blindness.

Health rights knowledge among medical school students at King Abdulaziz University, Jeddah, Saudi Arabia.

BackgroundHealth care is a basic human right, and Saudi Arabia affirms these rights for all its citizens.ObjectivesTo assess the knowledge of medical students regarding health rights in Saudi Arabia.MethodsThis cross-sectional study was conducted at King Abdulaziz University (KAU) from September 2015 through November 2015. A questionnaire written in English collected demographic data and included questions about reproductive health care and health rights of women and patients with cancer, senility, or special needs.ResultsOf the 267 participants, 184 (68.9%) were female, and 252 (94.4%) were Saudi. Regarding consent, 87 (32.6%) and 113 (42.3%) participants believed a female patient required the consent of a male guardian to receive medical treatment or surgery, respectively, in Saudi Arabia, and only 106 (39.7%) knew that a female patient could provide consent for a caesarean section. Sixty-six (24.7%) believed that abortion is never allowed in Islam. Only 93 (34.8%) were aware that acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) patients had health rights, about half (144, 53.9%) knew that cancer patients have a right to full information, and most (181, 67.8%) believed that a patient had the right to withhold health information from his/her family. Approximately half were aware that cancer patients have the right to free medical treatment (138, 51.7%) or that health rights applied to special needs patients (137, 51.3%) and senile patients (122, 45.7%).ConclusionsThe knowledge of KAU medical students regarding health rights of certain patient populations highlights the importance of health rights education in medical school.

Differences and risk factors of regimen modification in acquired immunodeficiency syndrome patients who initiated antiretroviral treatment

Objective To compare the rates of regimen modification between patients with different initial antiretroviral therapy, and to investigate risk factors associated with drug toxicity-related regimen modification. Methods A two-years retrospective cohort study was conducted in 14 060 patients who initiated antiretroviral treatment with Zidovudine (AZT)/Tenofovir disoproxil (TDF)+ Lamivudine (3TC)+ Efavirenz (EFV) since 2012. There were 5 126 patients initiated TDF+ 3TC+ EFV therapy (TDF group) and 8 934 patients initiated AZT+ 3TC+ EFV therapy (AZT group). Chi-square test was used to compare the rate of first-line regimen modification and the rate of toxicity-related regimen modification between two groups. Cox proportional hazard model was used to investigate the risk factors associated with regimen modification. Results A total of 14 060 acquired immunodeficiency syndrome patients were observed for a median period of 1.85 person-years. There were 2 795 patients who changed their initial antiretroviral regimen and the rate of initial regimen modification was 19.9%. Two hundred patients who changed their initial regimen due to pregnancy were excluded. There were 2 070 patients in AZT group who changed their initial regimen with a rate of 23.5%. Among them, 1 652 patients changed their regimen due to drug toxicity and the rate was 18.8%. There were 525 patients in TDF group who changed their initial regimen with a rate of 10.4% and the rate of toxicity-related regimen modification was 6.2%. The differences between two groups were statistical significance (χ2=366.68 and 416.89, respectively, both P<0.01). The risk of regimen modification in AZT group were significantly higher than that in TDF group (aHR=2.89, 95%CI: 2.57-3.24). The risk of toxicity-related regimen modification in AZT group was also significantly higher than that in TDF group (aHR=3.85, 95%CI: 3.34-4.45). Conclusions Patients initiated antiretroviral treatment with AZT+ 3TC+ EFV are more likely to change their initial regimen than those who initiated treatment with TDF+ 3TC+ EFV. Female, age >45 years old, BMI<18.5 kg/cm2 and baseline CD4+ T cell count<200/L were risk factors associated with regimen modification. Key words: Acquired immunodeficiency syndrome; Antiretroviral therapy; Regimen change; Drug side effects; Tenofovir

Research on risk factors of short-term outcome in AIDS patients with pneumocystis pneumonia

Objective: To investigate the prognostic risk factors of acquired immunodeficiency syndrome (AIDS) patients with pneumocystis pneumonia (PCP), and to establish risk models for predicting early outcome. Methods: The clinical data of 418 AIDS patients with PCP admitted to Department of Infectious Diseases, Beijing You'an Hospital, Capital Medical University from January 2008 to May 2016 were retrospectively analyzed.The patients were divided into death group and survival group according to clinical outcome during hospitalization.Data of the two groups were collected including general information and laboratory test results.Multivariate Logistic regression was used to analyze risk factors affecting prognosis of patients, establish prognostic models and evaluate predictive value of the model. Results: Of the 418 AIDS patients with PCP, 388 cases were male and 30 cases were female, aged from 5 to 82 years, mean age was (40±12) years.There were 82 patients in the death group and 336 patients in the survival group.Disease course, bacterial infection and alveolar-arterial oxygen pressure difference(P(A-a)O(2)), serum lactate dehydrogenase(LDH), white blood cell (WBC), neutrophil (N), alanine aminotransferase (AST), urea nitrogen (BUN) and serum potassium (K) were significantly higher in the death group than those in the survival group (all P<0.05), and arterial oxygen pressure (PaO(2)), blood oxygen saturation (SpO(2)), CD4(+) T lymphocyte count, lymphocyte (L) , hemoglobin (Hb), platelet (PLT), albumin (ALB), prealbumin (PALB), cholinesterase (CHE), cholesterol (CHO), serum chlorine (Cl) and serum sodium (Na) were significantly lower in the death group than those in the survival group (all P<0.05). Multivariate Logistic regression analysis showed that P(A-a)O(2, )ALB, LDH, N and CD4(+) T lymphocyte count were prognostic factors of AIDS complicated with PCP.Prognostic index=9.736+ 0.112×P(A-a)O(2)-0.719×ALB+ 0.006×LDH+ 0.355×N-0.021×CD4.ROC curve of the short-term prognostic model was 0.985 (95%CI 0.977-0.994), with P value 0.000, cut-off value 0.907, sensitivity 92.0% and specificity 98.8%.The mortality rate increased with the increase of equation value. Conclusions: P(A-a)O(2, )ALB, LDH, N and CD4(+) T lymphocyte count are independent risk factors to predict short-term prognosis in these patients.The short-term prognostic model based on independent risk factors is useful in guiding clinical treatment.

Pathogenic spectrum, clinical features and drug resistance of pneumonia caused by nontuberculous mycobacteria in acquined immunodeficiency syndrome patients

Objective To explore the pathogen spectrum, drug resistance rate and clinical characteristics of pneumonia caused by non-tuberculous mycobacteria (NTM) in acquined immuno-deficiency syndrome (AIDS) patients. Methods The clinical data of 31 hospitalized AIDS patients with bronchoalceolar lavage flind (BALF) culture confirmed NTM pulmonary disease in Guangzhou No. 8 People′s Hospital from January, 2008 to February, 2015 were retrospectively analyzed, including pathogen spectrum, drug resistance rate and clinical characteristics. The clinical characteristics and drug resistance were compared between Mycobacterium avmm-intracellulare complex (MAC) pneumonia and the non-MAC pneumonia, and t test and chi-square test were used. Results Of the 31 AIDS patients, 28 were male and 3 were female, with the mean age of 40.9 years old. The 31 NTM strains were consisted of 14 MAC strains and 17 non-MAC strains (including 4 M. kansasii strains, 3 M. lentiflavumstrains, 2 M. szulgai strains, 2 M. yongonense strains etc). There was no significant difference between two groups in sex ratio, mean age, clinical manifestations, laboratory tests and treatment outcome (all P>0.05). The major clinical manifestations included fever, productive cough, weight loss, anemia and low CD4+ count (<50/μL). Most patients showed thoracic lymphadenectasis and patchy shadows in lungs, and few patients had millet shadows and pericardial effusion. Compared with non-MAC strains, MAC strains had higher drug resistant rate of moxifloxacin (10/14 vs 4/17), levofloxacin (14/14 vs 8/17), and clarithromycin (11/14 vs 7/17). More extensively drug resistance strains were seen in non-MAC strains compared with MAC strains (11/14 vs 7/17). Conclusions MAC is the most common pathogen of NTM pulmonary disease in AIDS patients. The clinical features of pneumonia caused by MAC and non-MAC are similar, but drug resistance of MAC strains are more severe. Key words: Acquired immuno deficiency syndrome; Nontuberculous mycobacteria; Pneumonia; Mycobacterium avium complex; Drug resistance

Prevalence of Pneumocystis jirovecii among immunocompromised patients in hospitals of Tehran city, Iran.

Pneumocystis jirovecii is an opportunistic organism that can cause extreme complications such as Pneumocystis pneumonia in immunocompromised individuals. There is no comprehensive study was conducted Iran to determine the prevalence of this infection in susceptible individuals. In the present study, 160 sera samples were collected from immunocompromised patients, including acquired immunodeficiency syndrome (AIDS) patients, diabetic patients, Hodgkin lymphoma patients and non-Hodgkin lymphoma patients. The specimens were collected from Imam Khomeini and army's 501 hospitals. The specimens were examined using indirect fluorescent antibody test. The results of the study showed that 39.30% specimens were found positive, with different rates in different groups, including 20, 22.50, 37.50, and 77.50% of diabetic patients, non-Hodgkin patients, Hodgkin lymphoma patients, and AIDS patients, respectively. This occurrence is relatively high and can be a potential life-threatening hazard to infected patients in studied groups, on the other hand the organism can be transmitted from infected people to other susceptible individuals.

Evaluation of the virological and immune responses and their impact factors of Lopinavir/Ritonavir based second-line regimen in elderly acquired immunodeficiency syndrome patients who failed first line regimens

Objective To evaluate the virological and immune responses of Lopinavir/Ritonavir (LPV/r) based second-line regimen in elderly acquired immunodeficiency syndrome (AIDS) patients who failed first line regimens. Methods This was a retrospective cohort study. Elderly patients (≥50 years) who switched to LPV/r-based second-line antiretroviral therapy with human immuno-deficiency virus (HIV) RNA >1 000 copies/mL after more than 1 year of first-line treatment were recruited from Zhengzhou No.6 People Hospital from January 2010 to December 2011. The virological and immunological data during 60-month treatment were collected. Multivariate logistic regression was used to explore the risk factors associated with virological failure or immunological failure of 60-month second-line therapy. Results Totally 256 patients were enrolled with 109 male and 147 female. 89.5% were plasma donator. The median age at the time of switching to LPV/r based second-line regimen was 61 years old. Twelve out of the 256 cases were detected for genotypic drug resistance and ten of them were resistant to drugs. No resistance to protease inhibitor (PI) was found. After switching to LPV/r based second-line regimen, HIV viral suppression (HIV RNA≤400 copies/mL) rates at 12, 24, 36, 48, 60 months were 69.5%, 78.4%, 79.0%, 79.7%, and 83.2%, respectively. The CD4+ T cell counts were (313±135) /L at 12 months, (377±151) /L at 24 months, (396±155) /L at 36 months, (389±163) /L at 48 months and (412±147) /L at 60 months, which were all significantly higher than that at the initiation of therapy ([243±146] /L, t=19.092, 18.598, 12.843, 8.516 and 12.980, respectively; all P<0.05). After switching to LPV/r based second-line regimen for 60 months, 43 patients occurred virological failure and 48 patients occurred immunological failure. Multivariate logistic regression showed that poor adherence (OR=48.5, 95% CI: 15.9—98.4, P<0.01) and ART drug toxicity (OR=4.5, 95% CI: 2.6—11.3, P<0.01) were the main factors associated with virological failure at 60 months. Poor adherence (OR=15.1, 95% CI: 6.89—33.3, P<0.01), CD4≤100 /L at the time of switching therapy (OR=10.5, 95% CI: 5.1—21.7, P<0.01), concomitant medications (OR=3.6, 95% CI: 1.6—4.1, P<0.01) were main factors associated with immunological failure at 60 months. Conclusions Elderly patients (≥50 years) who failed first line regimen should switch to LPV/r contained regimen as early as possible. Adherence education should be strengthened, drug toxicity as well as complications of treatment should be managed in time and concomitant medications should be reduced. Key words: Acquired immunodeficiency syndrome; Antiretroviral therapy; Viral load; Immune response; ≥50 years old

Impact of alternative treatment approach for cerebral toxoplasmosis among HIV/AIDS patients from a resource-poor setting in Burkina Faso

Cerebral toxoplasmosis is caused by the protozoan Toxoplasma gondii because of reactivation of latent tissue cysts in the Acquired Immunodeficiency Syndrome (AIDS) patients with severe immunosuppression. The objective of this study was to evaluate the benefit of co-trimoxazole in presumptive and prevention of cerebral toxoplasmosis in Human Immunodeficiency Virus (HIV)/AIDS patients at Bobo-Dioulasso Hospital in Burkina Faso from June 2012 to October 2014. ELISA and ELFA were performed on serum for the quantitative determination of IgG and IgM anti-T. gondii, respectively. The seroprevalence of toxoplasmosis was 29.3%. No IgM antibodies for T. gondii were found. Six patients with Toxoplasma-specific antibodies presented cerebral toxoplasmosis. All patients were infected by HIV-1 with the median of CD4+ T lymphocytes at 141 cells/μl. No patient was under antiretroviral therapy. No case of cerebral toxoplasmosis was noted in patients receiving co-trimoxazole in prevention. Presumptive treatment of cerebral toxoplasmosis with co-trimoxazole was effective in all patients with a significant clinical improvement in 83.3%. These results attest the benefit of cotrimoxazole in cerebral toxoplasmosis treatment in countries where drug resources are limited when sulfadiazine is not available. Ours finding highlight the importance of establishing toxoplasmosis chemoprophylaxis to HIV with severe immunosuppression patients and positive Toxoplasma serology.

The clinical and laboratory spectrum of dedicator of cytokinesis 8 immunodeficiency syndrome in patients with a unique mutation.

Mutations in the dedicator of cytokinesis 8 (DOCK8) gene cause a combined immunodeficiency usually diagnosed as autosomal recessive hyper IgE syndrome. We sought to reveal the varying manifestations in patients with a unique mutation in DOCK8 gene by a retrospective medical record review. Ten patients from five consanguineous families and three tribes were included. Seven patients were homozygous for the c.C5134A, p.S1711X mutation, and the remaining three patients were their siblings manifesting hyper IgE syndrome features without a genetic diagnosis. Prior to the genetic diagnosis, the clinical diagnosis was "hyper IgE syndrome" in six patients and "anti-pneumococcal antibody deficiency," "recurrent pneumonia with bronchiectasis," and "asthma with hypereosinophilic syndrome" each diagnosed once. One additional patient was diagnosed due to family history. The age of presentation varied from 1 to 16months. Eczema was diagnosed in all patients, food allergies in three, and severe herpes keratitis or malignancy or autoimmunity in two patients. Elevated IgE was recorded in nine patients; however, in six patients, the initial serum IgE concentration was equal to or less than three times the normal concentration for age, and in these patients, the median age at IgE evaluation was 7.5months compared with 21.5months in patients with an initial IgE concentration above three times the normal concentration for age (P=0.067). The spectrum of disease manifestations in patients with a unique mutation in DOCK8 is variable. The genotype-phenotype correlations may be modified by genetic and/or epigenetic modifiers beyond the monogenic effect. Younger patients tend to have lower IgE concentrations at the initial measurement of IgE.

Knowledge, Awareness, and Behavior of Medical and Dental Interns toward Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Patients in Three Colleges of Madhya Pradesh, India: A Cross-sectional Survey

ABSTRACT Introduction India is one of the countries where a large population is affected by human immunodeficiency virus (HIV). It destroys the specific immune system cells called CD4 (cluster of differentiation 4) cells leading to an advanced condition called acquired immunodeficiency syndrome (AIDS). It is one of the life-threatening conditions. It is an infectious disease that can affect caregivers as well. These patients need to be treated with compassion and caution. The doctors need to be aware of the various types of infection, their symptoms, and precautions while treating them. Hence, there is a need to evaluate awareness and behavior among the medical and dental interns while dealing with patients suffering from HIV infection/AIDS patients. Materials and methods The present cross-sectional survey explored knowledge, awareness, and behavior of medical and dental interns toward HIV-infected/AIDS patients at People's University, Bhopal, India. A questionnaire consisting of 25 questions was given to the interns. A total of 350 interns were included in the study; 250 interns were from People's College of Dental Sciences &amp; Research Centre and People's Dental Academy, Bhopal, India, while 100 interns were from People's College of Medical Sciences, Bhopal, India. The collected data were analyzed and subjected to relevant statistics. Results Out of 350 questionnaires received, 250 were answered by dental interns and 100 were answered by medical interns. The mean and standard deviation (SD) of percentage knowledge score for dental interns was 76.57 ± 17.67 and for medical interns, it was 83.05 ± 11.04. Median of percentage knowledge score was 84.80 and 86.00 for dental and medical interns respectively. Mann—Whitney U-test showed no significant difference between dental and medical interns for percentage knowledge scores (p &gt; 0.05). The awareness score between the dental and medical interns showed that dental interns (82.34) showed slightly better awareness to the HIV patients than medical interns (81.00), although it was not statistically significant. When the behavior scores were compared between the dental and medical interns, the medical interns showed a higher score (85.4) compared with the dental interns (76.80), which was statistically significant (p &lt; 0.05). Conclusion The cross-sectional survey showed that medical students had better knowledge but dental interns had better awareness, though both were statistically not significant. The medical interns had better behavior score than dental interns, which was statistically significant. How to cite this article Ashok KP, Tripathi A, Ashok S. Knowledge, Awareness, and Behavior of Medical and Dental Interns toward Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Patients in Three Colleges of Madhya Pradesh, India: A Cross-sectional Survey. J Health Sci Res 2017;8(2):66-71.

Resveratrol-decreased hyperalgesia mediated by the P2X7 receptor in gp120-treated rats.

BackgroundChronic pain is a common symptom in human immunodeficiency virus (HIV)-1 infection/acquired immunodeficiency syndrome patients. The literature shows that the HIV envelope glycoprotein 120 (gp120) can directly cause hyperalgesia by stimulating primary sensory afferent nerves. The P2X7 receptor in the dorsal root ganglia (DRG) is closely related to neuropathic and inflammatory pain. In this study, we aimed to explore the effect of resveratrol (RES) on gp120-induced neuropathic pain that is mediated by the P2X7 receptor in the rat DRG.ResultsMechanical hyperalgesia in rats treated with gp120 was increased compared with that in the sham group. The P2X7 expression levels in rats treated with gp120 were higher than those in the sham group. Co-localization of the P2X7 receptor and glial fibrillary acidic protein (GFAP, a marker of satellite glial cells [SGCs]) in the DRG SGCs of the gp120 group exhibited more intense staining than that of the sham group. RES decreased the mechanical hyperalgesia and P2X7 expression levels in gp120 treatment rats. Co-localization of the P2X7 receptor and GFAP in the gp120+ RES group was significantly decreased compared to the gp120 group. RES decreased the IL-1β and TNF-α receptor (R) expression levels and ERK1/2 phosphorylation levels as well as increased IL-10 expression in the DRG of gp120-treated rats. Whole cell clamping demonstrated that RES significantly inhibited adenosine triphosphate-activated currents in HEK293 cells that were transfected with the P2X7 plasmid.ConclusionsRES relieved mechanical hyperalgesia in gp120-treated rats by inhibiting the P2X7 receptor.

Kidney Disease in Human Immunodeficiency Virus-seropositive Patients: Absence of Human Immunodeficiency Virus-associated Nephropathy was a Characteristic Feature.

Human immunodeficiency virus (HIV) infection can cause a broad spectrum of renal diseases. However, there is paucity of Indian data on the patterns of renal lesions in HIV-seropositive patients. The aim of the present study was to delineate the spectrum of renal lesions in HIV/acquired immunodeficiency syndrome patients. In this prospective study, all HIV-positive patients of both genders aged >18 years were screened for renal disease. Patients with proteinuria of more than 1 g/24 h were subjected to renal biopsy. A total of 293 HIV-positive patients were screened; of these, 136 (46.4%) patients found to have renal involvement. Dipstick-positive proteinuria of 1+ or more was observed in 112 (38.2%) patients, and 16 (14.2%) patients had proteinuria of more than 1 g/24 h. Renal biopsy in 14 cases revealed glomerulonephritis (GN) in 12 (85.7%) (isolated GN in 4 [28.5%] and GN mixed with chronic TIN in 8 [57.1%]) patients. These include mesangioproliferative GN in 5 (35.7%), membranoproliferative GN in 2 (14.2%), focal segmental glomerulosclerosis in 2 (14.2%), diffuse proliferative GN in 2 (14.2%), and diabetic nephropathy in 1 (7.1%) patients. Chronic interstitial nephritis was noted in 10 (71.42%) (superimposed on GN in 8 [57.1%], isolated in 2 [14.2%]) patients. Granulomatous interstitial nephritis was seen in 3 (24.1%) cases. GN and chronic interstitial nephritis were noted in 85.7% and 71.42% of patients, respectively, mostly superimposed on each other. Mesangioproliferative GN was the most common glomerular lesion, but classical HIV-associated nephropathy was not observed.

Toxoplasmosis in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome patients in a tertiary care hospital of Pune city of Maharashtra, India

Toxoplasmosis in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome patients in a tertiary care hospital of Pune city of Maharashtra, India