Infection In HIV-positive Patients Research Articles

CD4+ T cell count and HIV-1 viral load dynamics positively impacted by H. pylori infection in HIV-positive patients regardless of ART status in a high-burden setting

BackgroundThere is a widespread co-infection of HIV and Helicobacter pylori (H. pylori) globally, particularly in developing countries, and it has been suggested that this co-infection may affect the course of HIV disease. However, the interplay between H. pylori infection and HIV disease progression is not fully elucidated. In this study, we investigated the effect of H. pylori co-infection on CD4+ T cell count and HIV viral load dynamics in HIV-positive individuals in a high co-endemic setting.MethodsA comparative cross-sectional study was conducted among 288 HIV-positive and 175 HIV-negative individuals, both with and without H. pylori infection. Among HIV-positive participants, 195 were on antiretroviral therapy (ART) and 93 were ART-naïve. CD4+ T cell count and HIV-1 viral load were measured and compared between H. pylori-infected and -uninfected individuals, taking into account different HIV and ART status.ResultOur study demonstrated that individuals infected with H. pylori had a significantly higher CD4+ T cell count compared to uninfected controls among both HIV-negative and HIV-positive participants, regardless of ART therapy. Conversely, HIV/H. pylori co-infected participants had lower HIV-1 viral load than those without H. pylori infection. Linear regression analysis further confirmed a positive association between H. pylori infection, along with other clinical factors such as BMI, ART, and duration of therapy, with CD4+ T cell count while indicating an inverse relationship with HIV-1 viral load in HIV-positive patients. Additionally, factors such as khat chewing, age and WHO clinical stage of HIV were associated with reduced CD4+ T cell count and increased HIV-1 viral load.ConclusionOur study demonstrates that H. pylori co-infection was associated with higher CD4+ T cell count and lower HIV-1 viral load in HIV-positive patients, regardless of ART status. These findings show a positive effect of H. pylori co-infection on the dynamics of HIV-related immunological and virological parameters. Further studies are needed to elucidate the underlying mechanisms of the observed effects.

Evaluation of Different Blood Culture Bottles for the Diagnosis of Bloodstream Infections in Patients with HIV.

Bloodstream infection (BSI) is a significant factor contributing to hospitalization and high mortality rates among human immunodeficiency virus(HIV)-positive patients. Therefore, the timely detection of this condition is of utmost importance. Blood culture is considered the gold standard for diagnosing BSIs. Currently, BD BACTEC™ Plus Aerobic/F culture bottles and the BD BACTEC™ Myco/F Lytic culture bottles can be used for blood culture. This study aimed to evaluate the efficacy of two different types of culture bottles in diagnosing BSIs in patients with HIV. A retrospective analysis was conducted on HIV-positive patients hospitalized in the Infection Department of Wenzhou Central Hospital between July 2019 and October 2021. A total of 246 pairs of blood samples were included, consisting of an aerobic culture vial and a Myco/F culture vial. Blood culture results and clinical diagnosis were utilized to identify the presence of BSI. Out of 246 cases, 84 cases had positive blood cultures. Fungal BSIs, particularly Talaromycesmarneffei BSIs, were the most prevalent among patients with HIV. The positive rate of Myco/F culture bottles (89.29%) was significantly higher compared with aerobic culture bottles (69.05%; P = 0.001). In the diagnosis of fungal BSIs, the positive rate of Myco/F culture bottles was 88.57%, which was significantly higher than that of aerobic culture bottles (72.86%; P = 0.018). The Myco/F culture bottle has more advantages in diagnosing Talaromyces marneffei BSIs (P=0.028).In addition, mycobacteria were exclusively detected in Myco/F culture bottles. Fungal BSIs are the predominant type of infections in HIV-positive patients. Myco/F culture bottles exhibit noteworthy attributes of high positive rate in diagnosing HIV combined with BSI. These advantages are conducive to obtaining accurate culture results and minimizing missed diagnoses.

Clinical features of Talaromyces marneffei infection in HIV-positive and HIV-negative individuals: a retrospective study in southern China.

Talaromyces marneffei (TSM) is a temperature-dependent dimorphic fungus endemic to Southeast Asia and southern China. As the number of people at risk of TSM infection continues to increase, the clinical manifestations are becoming increasingly complex, posing challenges for clinical management. In this study, we analyzed the medical records of 99 patients (71 HIV-positive and 28 HIV-negative) diagnosed with TSM infection from January 1, 2017 to December 31, 2022 in southern China and compared the clinical manifestations in HIV-positive and HIV-negative patients. Most patients (83/99, 84%) were male. The incidence of skin and soft tissue involvement (48% vs. 21%, P = 0.016); disseminated infection with blood circulation, hematopoietic, lymphatic, alimentary, or central nervous system involvement (69% vs. 36%, P = 0.002); and gastrointestinal bleeding (33% vs. 9%, P = 0.023) was higher in the HIV-positive group than the HIV-negative group. The HIV-positive group also had significantly higher alanine aminotransferase levels (31 [26-42] vs. 14 [11-16]) U/L, P < 0.001) and alanine aminotransferase/aspartate transaminase ratio (1.9 [1.5-2.2] vs. 1.3 [1.1-1.6], P = 0.006) than the HIV-negative group. The time to diagnosis (5.5 ± 1.1 vs. 5.1 ± 1.4 days, P = 0.103), antifungal regimen (P = 0.278), case fatality rate (20% vs. 21%, P = 0.849), and relapse/reinfection rate (11% vs. 19%, P = 0.576) did not differ significantly between the HIV-positive and HIV-negative groups. Poor antiretroviral therapy adherence (OR=26.19, 95%CI 3.26-210.70, P = 0.002), advanced age (OR=1.13, 95%CI 1.03-1.23, P = 0.010), and Epstein-Barr virus co-infection (OR=37.13, 95%CI 3.03-455.64, P = 0.005) were independent risk factors for all-cause mortality from TSM infection in HIV-positive patients. Overall, the predominant infection sites, clinical manifestations, and complications of TSM infection differed by HIV status. However, with prompt diagnosis and appropriate treatment, HIV-positive patients with TSM infection can have similar outcomes to HIV-negative patients.

HIV Retinopathy and Immune Reconstitution Uveitis on CMV Retinitis: A Case Report

Aim: In HIV patients with CD4+count&lt;50cells/µL, after initiating HAART, close ophthalmological monitoring is mandatory, in order to watch for the development of IRU.&#x0D; Case Presentation: A 39-year-old patient with unknown medical history consulted for blurred vision and myodesopsia. The examination found bilateral microangiopathy with temporal retinal ischemia in the right eye.&#x0D; The patient was tested positive for HIV-1 with a CD4count of 43 cells/mm3. The diagnosis of HIV-microangiopathy was made, he received a prophylactic retinal argon-laser and was put on HAART.&#x0D; Following the HAART, he presented decreased VA in the right eye, with in examination, a slight inflammation of the AC, moderate hyalitis, and a diffuse and confluent temporal retinal necrosis.&#x0D; The diagnosis of IRU associated with CMV-retinitis was presumed.&#x0D; Discussion: The HAART increases the number of CD4-T-cells and restores immune responses against a wide variety of pathogens which reduces the incidence of opportunistic infections. However, in some patients, a dysregulated immune response after initiation of HAART leads to the immune reconstitution inflammatory disease, characterized by the paradoxical aggravation of a treated opportunistic infection or the revealing of a previously untreated subclinical infection in HIV-positive patients. The ocular manifestation of IRIS is called immune reconstitution uveitis (IRU).&#x0D; IRU usually develops in patients with inactive CMV retinitis, but it can rarely occur in eyes with active CMV retinitis and occurs within the first few weeks of starting HAART.&#x0D; Conclusion: The initiation of HAART requires regular general and ophthalmological monitoring in order to recognize early IRU which is often associated with active CMV retinitis.

Comparison of Genexpert MTB/RIF Assay and AFB Smear Microscopy in Diagnosis of Pulmonary Tuberculosis among HIV Patients at a Tertiary Care Hospital

Introduction: Tuberculosis (TB) has been the most common acute opportunistic infection in HIV positive patients and accounts for more than half of all AIDS cases in underdeveloped nations. Hence, rapid laboratory diagnosis of M. tuberculosis is needed for vulnerable patients. Methodology: In this study, 72 sputum samples were collected from ART-naive and patients using ART for 6 months. The samples were tested with the GeneXpert MTB / RIF assay to diagnose TB and drug resistance and AFB smear microscopy as per NTP guidelines. Results: Among 72 sputum samples studied, males were more diagnosed with TB than females. People aged 25-56 years were more infected with HIV-TB co-infection. Four patients (5.56%) were found to be TB positive with both techniques, 7 (9.72%) were GeneXpert MTB/RIF positive but smear-negative and 61 patients (84.72%) were negative with both methods. The positivity for MTB detected for GeneXpert MTB/RIF method in females was 3 (15%) and the males were 8 (15.38%), while for the ZN staining method the positivity in females was 2 (10%) and the males were 2 (3.85%). The GeneXpert MTB/RIF assay was also capable of detecting TB in smear-negative cases. Conclusion: This study showed that the GeneXpert MTB/RIF assay is an effective tool for the early diagnosis of TB among HIV patients as compared to AFB smear staining method.

Monkeypox and HIV in the Canary Islands: A Different Pattern in a Mobile Population.

Background. The clinical and epidemiological data of the recent outbreak of monkeypox (MPX) differ from previous reports. One difference is the epidemiological profile; the disease mainly affects a subgroup of MSM (men who have sex with men) with high-risk sexual behaviors, frequently persons living with human immunodeficiency virus (PLHIV). Methods. In this observational analysis, all patients with PCR (polymerase chain reaction)-confirmed MPX attending an Infectious Diseases and Tropical Medicine Unit in Gran Canaria (Spain) between May and July 2022 were considered. Results. In total, 42 men were included; 88% were identified as MSM, with a median age of 40 years. Only 43% were born in Spain. All the patients had systemic symptoms and skin lesions. The distribution of lesions was more frequent in the genital/anal region, and the involvement of hands and feet was less common. Fever and lymphadenopathies were less frequent than in other series. Other unusual manifestations were proctitis, pharyngitis and penile–scrotal edema. Half of the patients had other associated infections (mainly STIs, sexually transmitted infections), and 60% of the monkeypox patients had PLHIV (People Living with HIV). When comparing the clinical characteristics between HIV-positive and -negative patients, we found three main differences: (i) a higher frequency of perioral lesions, (ii) a higher frequency of pharyngitis and (iii) a higher number of sexually transmitted infections in HIV-positive patients. Conclusions. The clinical findings in this outbreak of MPX had great variability in presentation. Several clinical differences were found in PLHIV-coinfected patients.

HIV Infection and Secondary Bacterial and Fungal Respiratory Tract Infections in Central Indian Patients, as Well as a Heart Survey

Background: Respiratory tract infections (RTI) can cause severe morbidity and morbidity in HIV-uninfected patients with even intact full functioning immune system, and for the majority of HIV paglents, RTl are the first secondary infections which may infect even detect HIV-positivity in some of the cases. In this study attempt has been made to correlate the degree of damage to immune system of the HIV patients and different etiological agents of RTl. Naturally, in HIV-infected, Immuno-compromised patients the prevalence of routine bacteriological and fungal RTl would be more, this study is designed to know exact prevalence rate of RTl in HIV patients of this region. RTl has broad spectrum of fungal and bacterial etiology, when combined with HIV, this feature confuses the treating physician. Without knowledge of incidence of common etiological agents and their susceptibility/ pattern it is difficult for him to select the right drug for treatment.&#x0D; Aim: HIV Infection and Secondary Bacterial and Fungal Respiratory Tract Infections in Central Indian Patients, as well as a Heart Survey.&#x0D; Material and Method: Secondary infections of the upper and lower respiratory tract are highly common in HIV-positive patients, and the majority of them have a bacterial etiology. The respiratory tract infections of HIV-infected patients do not differ too much than HIV-uninfected patients, except in degree. This study was done on a total number of 200 sputum samples collected from ICTC and ART Center during the study period. &#x0D; Results: The HIV-positive patients were the ones who had the highest polymicrobial isolation. PCP was not detected in our investigation, perhaps due to the nature of the sample, which was sputum. According to the findings of this study, Mycobacterium tuberculosis, Klebsiella pneumoniae, Candida albicans, and Pseudomonas aeruginosa are the most common opportunistic pathogens among HIV-positive people in the Central Indian regions investigated. Constant monitoring of infections in HIV positive patients is crucial for better management and to improve the quality of life of such patients, due to the changing pattern of infections based on the degree of immuno-suppression.&#x0D; Conclusion: Despite the risks of side effects, the provision of highly active antiretroviral therapy in underdeveloped countries like ours should be supported, especially since these life-saving drugs are still unavailable to the vast majority of patients who require them. Even though there are certain side effects, HIV patients are advised to continue taking HAART. However, in order to manage the morbidity associated with HAART, appropriate clinical follow-up is also essential, and all of these factors may help them live longer.&#x0D; Keywords: Respiratory tract infections, Immuno-compromised patients, Human Immunodeficiency Virus, AIDS and HAART

Clinico-etiological profile of lower respiratory tract infections in HIV-positive patients

Background: The type of pathogens responsible for opportunistic infections in human immunodeficiency virus (HIV)-infected persons varies from region to region. Till date, very few studies covering respiratory tract infections in HIV-positive patients have been conducted in this part of the country. This study was conducted in order to get better understanding of the clinical picture of lower respiratory tract infections (LRTIs) in HIV-positive patients in this region. Aim: The aim was to study the LRTIs in HIV-positive patients. Settings and Design: Eighty-one patients were diagnosed as HIV-positive with LRTIs, attending to Department of Medicine at Assam Medical College and Hospital, Dibrugarh, Assam, India. Materials and Methods: Personal and family history was collected with emphasis on the duration of HIV-positive status, any chronic illness, sexually transmitted diseases, history of blood transfusions, or any surgical procedures. A detailed general and systemic examination was done. Statistical Analysis Used: The data collected were tabulated in MS Excel and analyzed using SPSS 20.0. The categorical variables were summarized as frequency and percentages. Results: Mycobacterium tuberculosis was responsible for 18.52% of cases of LRTIs, whereas fungal etiology was found in 7.41% of the cases. The most common bacterial and fungal pathogens isolated were Streptococcus pneumoniae (23.46%) and Candida albicans (7.41%), respectively. Conclusion: Low CD4 cell count is an important indicator for the risk of pulmonary tuberculosis and fungal LRTIs, as shown in our study. Periodic CD cell count in HIV-positive patients is important in this regard.

Investigating the risk factors for seroprevalence and the correlation between CD4+ T-cell count and humoral antibody responses to Toxoplasma gondii infection amongst HIV patients in the Bamenda Health District, Cameroon.

Toxoplasmosis is caused by an obligate intracellular tissue protozoan parasite, Toxoplasma gondii that infect humans and other warm-blooded animals. Transmission to humans is by eating raw or inadequately cooked infected meat or through ingestion of oocysts that cats have passed in faeces. Studies have shown life-threatening and substantial neurologic damage in immunocompromised patients; however, 80% of humans remain asymptomatic. The aim of this study was to determine the seroprevalence of Toxoplasma gondii infection in HIV positive patients and the risk factors associated with the infection, and to investigate the correlation between CD4+ T-cell count and toxoplasma specific antibodies as possible predictors of each other amongst HIV patients in the Bamenda Health District of the North West Region of Cameroon. A cross-sectional study was conducted, in which 325 HIV patients were recruited for administration of questionnaire, serological diagnosis of T. gondii and measurement of CD4+ T-cell count. Bivariate and multivariate logistic regression was used to identify risk factors associated with T. gondii infection while the linear regression was used to investigate the relationship between CD4+ T-cell count and antibody levels against T. gondii. The findings showed that, majority (45.8%) of HIV patients suffered from chronic (IgG antibody) infection, and 6.5% from acute (IgM and IgM/IgG antibody) toxoplasma infection. The overall sero-prevalence of T. gondii infection amongst HIV patients was 50.5%. On the whole, 43 men (45.7%) and 127 women (55%) presented with anti- T. gondii antibodies; however, there was no significant difference amongst males and females who were positive to T. gondii infection (p = 0.131). Marital status (p = 0.0003), contact with garden soil (p = 0.0062), and garden ownership (p = 0.009), were factors that showed significant association with T. gondii infection. There was no significant difference (p = 0.909) between the mean CD4+ T-cell count of HIV patients negative for toxoplasma infection (502.7 cells/mL), chronically infected with T. gondii (517.7 cells/mL) and acutely infected with T. gondii (513.1 cells/mL). CD4+ T-cell count was neither a predictor of IgM antibody titer (r = 0.193, p = 0.401), nor IgG antibody titer (r = 0.149, p = 0.519) amongst HIV patients acutely infected with T. gondii. The findings from this study underscore the need to implement preventive and control measures to fight against T. gondii infection amongst HIV patients in the Bamenda Health District.

Parasitic and Vector-Borne Infections in HIV-Positive Patients in Slovakia-Evidence of an Unexpectedly High Occurrence of Anaplasma phagocytophilum.

In HIV (human immunodeficiency virus) infected people, the immunodeficiency caused by a reduced level of CD4 (cluster of differentiation 4) T-lymphocytes increases the risk of infectious diseases. Additionally, in individuals with immunologically compromising conditions, tick-borne or some parasitic pathogens may cause chronic, debilitating opportunistic infections and even death. The study aimed at determining the IgG seropositivity of HIV-infected patients to Toxoplasma gondii, Toxocara spp., Echinococcus multilocularis, and E. granulosus s.l. and performing the molecular identification of T. gondii and some tick-borne pathogens, namely, Borrelia spp., Babesia spp., Anaplasma phagocytophilum, Rickettsia spp., and Bartonella spp. Out of 89 HIV-positive patients, specific IgG antibodies to T. gondii were detected in 17 (19.1%) and to Borrelia spp. in 12 (13.5%) individuals. Seropositivity to Toxocara spp., E. multilocularis, and E. granulosus s.l. was not recorded. Molecular approaches showed positivity to T. gondii in two (2.2%) patients, and 11 (12.4%) individuals had positive PCR signal for the msp2 gene of A. phagocytophilum. Relatively high prevalence of A. phagocytophilum in HIV-positive patients suggests that these people are more susceptible to some vector-borne pathogens. The presence of opportunistic infections may pose a health risk for patients with weakened immune systems, and should not be neglected during the regular monitoring of the patient’s health status.

Sero-Molecular Detection of Toxoplasma Gondii Infection among HIV-Positive Patients in Khartoum : A Cross Sectional Study

Background and Aim : Toxoplasmosis is one of the most common comorbidities in HIV-positive patients with CD4+ T lymphocytes below 200 cells/μl. Toxoplasmosis with encephalitis may affect HIV infection, in particular in patients with developing AIDS. Early diagnosis and treatment of toxoplasmosis reduces the mortality rate in HIV-positive people. The aim of this study was to estimate the seroprevalence of Toxoplasma gondii infection in HIV-positive patients in Khartoum, Sudan using serological and molecular methods. Methods : This was a descriptive cross sectional, hospital based study, blood sample were collected from 100 participants; out of them were 50 HIV/AIDS patients and 50 were healthy Blood donors attending HIV Center -Omdurman Hospital, and Sudan Heart Center blood bank respectively. Socio- demographic data were collected by structured questionnaire. Of the 50 HIV/AIDS patients, 25 (50%) were from each gender, their age ranged between 22 and 62 with mean of 39.5+10.69. They were classified into two age groups; from 22 to 42 years, and from 43 to 62 years, and their distribution was 29 (58%), and 21 (42%) respectively. According to the clinical stage they were classified into the four clinical-stage groups and their distribution was as following: 06 (12.0%) in stage 1, 02 (04%) in stage 2, 40 (80.0%) in stage 3, and 02 (04.0%) in stage 4. Twelve of them (22%) were under ART treatments. The 50 blood donors on their hand were all males, their age was ranged between 18 and 42 years old. Regarding their educatio, 15 (30%) were educated, while the remaining 35 (70%) were none educated. Mentioning their marital status 10 (20%) were married, while 40 (80%) were single. Regarding the contact with cats 25 (50%) has contact with cats. All samples collected were tested for anti-Toxoplasma IgG and IgM antibodies by ELISA, and by PCR for detection of Toxoplasma DNA.. Results: Out of the 50 HIV/AIDS patients; Anti-Toxoplasma IgM was detected in two patients (04%), while IgG was detected in 08 (16%) patients, the Toxoplasma DNA was detected in three (06%) patients.Regarding the blood donors group; all studied blood donors showed negative results for anti-toxoplasma IgM, while 16 (32%) showed positive anti-Toxoplasma IgG.No blood donors sample was detected positive for Toxoplasma DNA with PCR. There were no significant differences in comparison between the blood donors and the HIV/AIDS patients regarding serological and molecular toxoplasma test results. Conclusion : The current study showed a relatively high seroprevalance of anti-T.gondii IgG and low IgM antibodies in HIV-positive patients in comparison with previous studies in Sudan. Considering the relatively high seroprevalance rate of toxoplasma infection in blood donors reported in this study, toxoplasmosis should be considered as a significant transfusion risk.

Failure to eradicate Helicobacter pylori infection is more frequent among HIV-positive patients.

Helicobacter pylori is a worldwide infection, but little is known about the efficacy of treatment for H.pylori infection in HIV-positive patients. The goal of this work was to evaluate outcomes after first-line H.pylori treatment and identify risk factors for failure in HIV-positive patients. This registry study of unmatched H.pylori-infected HIV-positive patients and HIV-negative obese pre-bariatric surgery controls was performed in a tertiary university hospital. Cases were enrolled from 2006 to 2017, controls from 2007 to 2014, and both received standard of care. An additional 'optimal' subgroup of cases was enrolled prospectively from 2017 to 2019 which was treated only on the basis of antibiogram, drug interaction search and additional support by one referent physician. Helicobacterpylori eradication failure rates were compared according to clinical, microbiological and pathological parameters and treatment. We analysed 258 HIV-positive patients and 204 HIV-negative control patients. Helicobacterpylori eradication failure rates were markedly greater in cases (24.1%) than in controls (8.8%). The proportions of levofloxacin and metronidazole resistance were greater in cases than in controls (P<0.05). Among cases treated with H.pylori triple therapy (S3T), the 'optimal' subgroup experienced a 9.5% failure rate vs. 28.6% with other strategies (P=0.01). Risk factors for failure were H.pylori treatment strategy, exposure to antiretroviral treatment, and alcohol status. Overall, positive HIV status was a risk factor for S3T eradication failure. Patients co-infected with H. pylori and HIV frequently failed to eradicate H.pylori and this was related to treatment strategy, antiretroviral exposure and lifestyle.

Determinants of Opportunistic Infections Among HIV-Positive Patients on HAART in Debre Berhan Referral Hospital, North Shoa Zone, Ethiopia, 2020: A Case-Control Study.

IntroductionOpportunistic infections are an illness that exists more frequently and is more severe in people with HIV. In HIV/AIDS patients, opportunistic infections still cause morbidity and mortality even after the era of highly active antiretroviral therapy (HAART) and most patients die as direct or indirect complications of opportunistic infections. This study was aimed to identify the determinants for the occurrence of opportunistic infections in HIV-positive patients having HAART follow-up in DBRH, Debre Berhan, Ethiopia.MethodsA total of 339 study subjects were involved under institution-based unmatched case–control study design and simple random sampling technique. A pre-tested structured questionnaire was used for data collection. Data were entered using Epidata version 3.1 and analyzed for descriptive and logistic regression models by SPSS version 21. A P-value of less than 0.05 was considered as statistically significant.ResultsAfter adjusting potential confounders, drinking alcohol (AOR=3.12, 95% CI: 1.07–9.06), BMI <18.5 (AOR= 3.36, 95% CI: 1.49–7.55), previous history of opportunistic infections (AOR= 2.96, 95% CI: 1.51–5.8) were independent predictors of opportunistic infections in people living with HIV/AIDS on HAART.ConclusionIn this study, the poor clinical and biochemical status, and behavioral factors were being the predictors of the occurrence of opportunistic infections. HIV/AIDS patients must be assessed and screened for opportunistic infections.

What Are the Risk Factors for Surgical Site Infection in HIV-Positive Patients Receiving Open Reduction and Internal Fixation of Traumatic Limb Fractures? A Retrospective Cohort Study.

A lack of studies analyze risk factors associated with surgical site infection (SSI) in human immunodeficiency virus (HIV)-positive patients with trauma undergoing orthopedic surgery. We questioned, (1) "What is the proportion of SSI in HIV-positive patients receiving open reduction and internal fixation (ORIF) of traumatic limb fractures?" and (2) "What are the independent risk factors for SSI of HIV-positive patients with traumatic limb fractures who received ORIF?" A retrospective study was performed in our institution from May 2011 to December 2019. A total of 246 patients were enrolled. Data of HIV-positive adult patients with traumatic limb fractures treated by ORIF were extracted from the electronic medical records, including the demographic information, characteristics of fractures, treatment-related variables, and indexes of laboratory examination. Multivariable logistic regression was used to identify independent predictors of SSI. A total of 26 patients developed SSI in this study, the overall proportion was 10.6% [95% confidence interval (CI) = 7.2%-15.3%]. Among them, 18 cases (7.3%) suffered from superficial SSI and 8 cases (3.3%) had the deep SSI. Independent predictors of SSI identified by multivariable logistic regression analysis were CD4+ T-lymphocyte count (adjusted odds ratio per 100/μL increase = 0.55; 95% CI = 0.37-0.81; p = .002) and albumin (adjusted odds ratio per 5 g/liter increase = 0.50; 95% CI = 0.30-0.81; p = .003). We recommend that orthopedic surgeons assess immunosuppression and nutritional status of HIV-positive patients rigorously and optimize the perioperative strategy of supplementary to reduce the risk of SSI.

Pharmaceutical care-based outcomes, medication-related problems and tuberculosis infection in HIV positive patients on second-line antiretroviral therapy

The Ceylon Journal of Medical Science (CJMS) since its re-launch in 2016 is the official journal of the Faculty of Medicine, University of Colombo. The focus of the CJMS is to provide a platform to those involved in diverse fields of medical science to publish high quality research. This will facilitate promotion of evidence based medicine and thereby improve health care. This platform is open to doctors, researchers, scientists in medical sciences and medical education and students in both medical and allied health sciences. The CJMS is an open access, peer-reviewed journal.

Experience with 13-valent conjugated pneumococcal vaccine in HIV-infected patients

Evaluate the effect of PCV13 vaccination on the composition of the microflora of the upper respiratory tract and the immune system in HIV-infected patients. 100 patients with HIV-infection were included in the study. The patients underwent immunological examination and the collection of biomaterial from the posterior pharyngeal wall for microbiological examination. After obtaining the results of the examinations, PCV13 was intramuscularly administered. 7 days after the introduction of the vaccine, an assessment of adverse events was carried out, after 3 months, microbiological and immunological examinations were repeated. Immediately after the administration of PCV13, 5% of patients felt pain during the administration. Local reactions were reported in 6 patients. One participant showed a rise in temperature to 38.3C over 2 days. Before vaccination, 16 strains of S. pneumoniae were seeded in patients. 3 months after the administration of PCV13, pneumococcus was isolated in 8 patients. 3 months after immunization, the median level of populations and subpopulations of lymphocytes became higher than the pre-vaccination. Our results show high risk of pneumococcal infections in HIV-positive patients. A tendency towards a decrease in the level of S. pneumoniae carriage was revealed 3 months after the administration of PCV13. The high level of enterobacteria carriage in HIV-positive patients is noteworthy. There is a pronounced positive effect from the use of PCV13 in HIV-positive patients on cellular factors of the immune system. The use of PCV13 is a safe and effective method for the prevention of S. pneumoniae infections.

Two Serial Case of Coronavirus Disease-19 Patients Coinfected with HIV: Comparison of Pre-anti-Retroviral (art) and on Art Patient

BACKGROUND: Today, coronavirus disease (COVID)-19 has become a worldwide pandemic. People living with HIV are one of the special populations who are susceptible to COVID-19 infection and suspected of having a poor prognosis.&#x0D; CASE REPORT: We reported two serial cases of COVID-19 with HIV coinfection. First case was a COVID-19 patient coinfected with HIV who had received anti-retroviral therapy (ARV) and had an absolute CD4 cell count of 781 cells/uL. Patient was found with mild symptoms of COVID-19 and had normal laboratory results and chest X-ray. Patient was declared cured after 26 days of treatment in isolation room with complete clinical improvement since day 5 of isolation. Second case was a COVID-19 with HIV coinfection that had not yet received ARV therapy and had absolute CD4 cell count of 155 Cell/uL. Patient came with moderate clinical symptom of COVID-19 and experienced secondary bacterial and tuberculosis infection. Patient was declared cured of COVID-19 on the 8th day of treatment with clinical improvement but still needed further treatment in a non-isolation room.&#x0D; CONCLUSION: Clinical characteristics of COVID-19 in HIV and non-HIV patients are the same. A history of ARV therapy and CD4 count did not affect the length of isolation until a negative result on two reverse-transcription-polymerase chain reactions, but could affect prognosis and clinical severity due to the high risk of secondary infection in HIV-positive patients without ARV or HIV/AIDS who had a CD4 count ≤200 cell/uL.

Ocular Presentations in Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) Patients undergoing highly- active antiretroviral therapy (HAART) Therapy in Jeddah, Kingdom of Saudi Arabia.

Purpose:&#x0D; To detect the Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) related ocular manifestations in Jeddah, Saudi Arabia.&#x0D; Study Design: Retrospective study&#x0D; Place and duration of study: A one-year retrospective study was conducted in Ophthalmology Clinic of East Jeddah Hospital in the western region of the Kingdom of Saudi Arabia, during 2016-2017&#x0D; Material and methods&#x0D; A one-year retrospective study was conducted in the Ophthalmology Clinic of East Jeddah Hospital in the western region of the Kingdom of Saudi Arabia, during 2016-2017. 47 referrals of HIV-positive patient data were collected from the Infectious Diseases Department by taking history, clinical examinations and, laboratory investigations. The ophthalmological examination included adnexal examination, bestcorrected visual acuity, intraocular pressure (IOP), anterior and posterior segment examination, B-scan and, MRI.&#x0D; Results&#x0D; Out of 47 referred patients from the In and Out-patient Departments in East Jeddah Hospital, patients presented as follows:&#x0D; Single patient cases of retinal necrosis, anterior uveitis and neovascular glaucoma, with pterygium,sixth nerve palsy, bacterial conjunctivitis and, adenoviral conjunctivitis. Two cases presented with HIV microangiopathy, blepharitis, cortical blindness after brain abscess, herpes infection, Kaposi sarcoma and, cytomegalovirus (CMV) retinitis. Three patients presented with tuberculosis meningitis, and six with dry eyes. Eight patients presented with cataracts, and ten with refractive errors.&#x0D; Conclusions&#x0D; Ocular manifestations of HIV infection are relatively infrequent.HAART treatment is responsible for decreasing the HIV-related complications in ophthalmology. The CD4 T-lymphocyte result can be used to predict the beginning of certain eye infections in HIV-positive patients. Hidden indicators of complications of AIDS in patients confirm the strong rationale for alternating visits with those to an ophthalmologist and professionals discussing the best treatment accordingly.&#x0D; Keywords: Ocular, HIV, AIDS, HAART

Cryptosporidiosis in HIV-positive patients and related risk factors: A systematic review and meta-analysis.

Cryptosporidium is one of the major causes of diarrhea in HIV-positive patients. The aim of this study is to systematically review and meta-analyze the prevalence of Cryptosporidium in these patients. PubMed, Science Direct, Google Scholar, Web of Science, Cochrane and Ovid databases were searched for relevant studies dating from the period of 1 January 2000 to 31 December 2017. Data extraction for the included studies was performed independently by two authors. The overall pooled prevalence was calculated and subgroup analysis was performed on diagnostic methods, geographical distribution and study population. Meta-regression was performed on the year of publication, proportion of patients with diarrhea, and proportion of patients with CD4 < 200 cells/mL. One hundred and sixty-one studies and 51,123 HIV-positive participants were included. The overall pooled prevalence of Cryptosporidium infection in HIV-positive patients was 11.2% (CI95%: 9.4%–13.0%). The pooled prevalence was estimated to be 10.0% (CI95%: 8.4%–11.8%) using staining methods, 13.5% (CI95%: 8.9%–19.8%) using molecular methods, and 26.3% (CI95%: 15.0%–42.0%) using antigen detection methods. The prevalence of Cryptosporidium in HIV patients was significantly associated with the country of study. Also, there were statistical differences between the diarrhea, CD4 < 200 cells/mL, and antiretroviral therapy risk factors with Cryptosporidiosis. Thus, Cryptosporidium is a common infection in HIV-positive patients, and safe water and hand-hygiene should be implemented to prevent cryptosporidiosis occurrence in these patients.

Potential Impact of SARS-CoV-2 Infection in HIV-positive Patients in South Africa

ABSTRACTCoronaviruses are important causes of infection in both humans and animals. While in the past they were considered to be relatively harmless respiratory pathogens, outbreaks of infection with severe acute respiratory syndrome (SARS), Middle East respiratory syndrome, and currently SARS-CoV-2, have confirmed how serious these pathogens can be in respiratory tract infections. Certain conditions and underlying comorbidities are known to be risk factors for SARS-CoV-2 infection, and for associated severe disease, including older age, underlying chronic cardiovascular and respiratory conditions and diabetes mellitus. There are a number of additional conditions and comorbidities that are suspected as being important risk factors, but for which hard evidence is currently lacking. This includes underlying human immunodeficiency virus infection, which represents the major focus of this current survey of the scientific literature.