Infections In HIV-infected Patients Research Articles

Acceptance of chronic disease in patients living with HIV infection: one centre's cross-sectional study

Background: Despite effective treatment, the quality of life of patients infected with Human Immunodeficiency Virus (HIV) can be diminished by factors both directly and indirectly related to the infection.Aim of the study: Determination of factors affecting the acceptance of HIV infection as a chronic disease in HIV-infected patients. Material and methods: A survey was conducted on 83 HIV-infected adults undergoing antiretroviral (ARV) treatment. The impact of social and medical factors on the acceptance of a chronic disease such as HIV infection was analyzed. Factors such as age, gender, education, route of HIV infection, living with family or a close person, professional activity, length of ARV therapy, history of an indicator disease, treatment breaks, markers of HBV infection, and current comorbidities requiring treatment, which may affect self-acceptance, were included in the analysis. Information about the patients was obtained from the Acceptance of Illness Scale (AIS) survey and medical records.Results: On average, in the AIS survey, patients scored 33.98 points, with a maximum of 40, which proves a very good acceptance of their infection. Among the many analyzed factors, only two variables showed statistical significance. Professionally active people accept their infection better, while lower acceptance was observed in patients who discontinued ARV therapy in the past.Conclusions: The analysis of the data from the study shows the need to consider many factors influencing the acceptance of HIV infection in HIV-infected patients. This will allow the introduction of programs to improve care for people with a chronic disease and thus improve their quality of life. The high assessment of acceptance of their disease was undoubtedly influenced by professional activity, the effectiveness of ARV treatment, and good access to ARV drugs.

Nanopore targeted sequencing-based diagnosis of central nervous system infections in HIV-infected patients

BackgroundEarly and accurate etiological diagnosis is very important for improving the prognosis of central nervous system (CNS) infections in human immunodeficiency virus (HIV)-infected patients. The goal is not easily achieved by conventional microbiological tests. We developed a nanopore targeted sequencing (NTS) platform and evaluated the diagnostic performance for CNS infections in HIV-infected patients, with special focus on cryptococcal meningitis (CM). We compared the CM diagnostic performance of NTS with conventional methods and cryptococcal polymerase chain reaction (PCR).MethodsThis study included 57 hospitalized HIV-infected patients with suspected CNS infections from September 2018 to March 2022. The diagnosis established during hospitalization includes 27 cases of CM, 13 CNS tuberculosis, 5 toxoplasma encephalitis, 2 cytomegalovirus (CMV) encephalitis and 1 Varicella-zoster virus (VZV) encephalitis. The 2 cases of CMV encephalitis also have co-existing CM. Target-specific PCR amplification was used to enrich pathogen sequences before nanopore sequencing. NTS was performed on stored cerebrospinal fluid (CSF) samples and the results were compared with the diagnosis during hospitalization.Results53 (93.0%) of the patients were male. The median CD4 cell count was 25.0 (IQR: 14.0–63.0) cells/uL. The sensitivities of CSF culture, India ink staining, cryptococcal PCR and NTS for CM were 70.4% (95%CI: 51.5 − 84.1%), 76.0% (95%CI: 56.6 − 88.5%), 77.8% (59.2 − 89.4%) and 85.2% (95%CI: 67.5 − 94.1%), respectively. All those methods had 100% specificity for CM. Our NTS platform could identify Cryptococcus at species level. Moreover, NTS was also able to identify all the 5 cases of toxoplasma encephalitis, 2 cases of CMV encephalitis and 1 VZV encephalitis. However, only 1 of 13 CNS tuberculosis cases was diagnosed by NTS, and so did Xpert MTB/RIF assay.ConclusionsNTS has a good diagnostic performance for CM in HIV-infected patients and may have the ability of simultaneously detecting other pathogens, including mixed infections. With continuing improving of the NTS platform, it may be a promising alterative microbiological test for assisting with the diagnosis of CNS infections.

Molecular markers of acute intestinal infections in HIV-infected patients in the Chechen Republic

Introduction. Diarrheal syndrome is the most characteristic symptom of HIV infection, which occurs in 70% of patients and is often fatal. The severity of diarrheal syndrome, irrespective of immune status, is usually determined by specific microorganisms colonising the gastrointestinal tract.
 The objective of this study is to assess the prevalence of classical pathogens of acute intestinal infections in diarrheal syndrome in HIV-infected residents of the Chechen Republic (Grozny).
 Materials and methods. Stool samples (n = 191) of HIV-infected patients with a history of diarrheal syndrome were studied by real-time PCR with two kits of reagents: "AmpliSens OKI screen-FL" for the detection of DNA/RNA of Shigella spp./EIEC, Salmonella spp., Campylobacter spp., Adenovirus, Rotavirus, Norovirus and Astrovirus; "AmpliSens Escherichiosis-FL" for the detection of diarrheagenic E. coli (DEC) DNA of five pathogroups: EPEC, EHEC, ETEC, EIEC, EAgEC.
 Results. Genetic markers of the acute intestinal infection pathogens were detected in 20.9% of the examined individuals. In patients aged 0–7 years and 18–24 years, DNA/RNA of the tested pathogens were not detected. DNA of bacterial pathogens accounted for 93.9%, RNA of viral pathogens — 6.1%. The etiological structure of bacterial infections was represented by a significant predominance of DEC (84.8%) compared to 10.9% of Campylobacter spp. and 4.4% of Salmonella spp. The structure of viral infections included 66.7% Rotavirus and 33.3% Norovirus. Genetic markers of Adenovirus and Astrovirus have not been identified. In 77.5% of HIV-infected patients, diarrheal syndrome was caused by one pathogen (mono-infection), but in nine examined patients (22.5%) it had a combined etiology.
 Conclusion. The etiology of acute intestinal infections in HIV-infected patients of the Chechen Republic includes bacterial and viral pathogens, in every fifth the cause of diarrheal disease was DEC. Due to diarrhea in HIV-infected people being a polyetiological disease, it is necessary to introduce a comprehensive, fast, reliable, and affordable method for identifying a wide range of pathogens that cause secondary infections.

Chronic or recurrent Campylobacter enteritis in primary immunodeficiency: a UK national case-series and review of the literature.

Chronic or recurrent Campylobacter enteritis in primary immunodeficiency: a UK national case-series and review of the literature.

Relationship of Serum Zinc Level and Macro/Micronutrients with CD4 Levels in HIV Patients

Background: Deficiencies of micronutrients increase the risk of various infections in HIV-infected patients. Zinc deficiency in HIV-infected patients may be associated with decreased CD4 cell counts. Objectives: In this regard, the present study investigated the association between serum zinc levels, macro/micronutrient intake, and CD4 counts in HIV patients. Methods: The research population of this study included 194 adult HIV patients aged 18 to 70 years referred to Shiraz Behavioral Diseases Center, Shiraz, Iran. The CD4 cell counts were extracted from patients’ records. Serum zinc level was measured using atomic absorption method. Univariate and multivariate comparison of macro/micronutrient and food items with CD4 cells was performed using linear regression and SPSS20, and P < 0.05 was considered statistically significant. Results: Fifty-seven percent were male, and the mean age and SD of total participants was 43.76 ± 9.06 years. The association between serum zinc levels and CD4 serum count is close to the significance level (P = 0.05), but the dietary zinc intake was not significantly correlated with serum CD4 counts (P = 0.26). Vegetable intake (P < 0.001) and fruits (P = 0.01) as well as absorption of vitamin A (P = 0.002), vitamin C (P < 0.001), beta-carotene (P = 0.002), folate (P = 0.05), and fiber (P = 0.01) from diet showed a direct and significant association with serum CD4 levels in HIV patients. Consumption of hydrogenated oils (P = 0.04) showed a significant inverse association with serum CD4 levels in these patients. Conclusions: Evaluation of serum micro/macronutrients can play an essential role in the development of appropriate dietary and supplement guidelines provided by the healthcare system for HIV-infected patients, and it can influence the decision- and policy-making regarding the control of non-pharmacological management of these patients.

A RARE CASE OF DISSEMINATED MYCOBACTERIUM AS THE CAUSE OF RECURRENT PNEUMOTHORAX

A RARE CASE OF DISSEMINATED MYCOBACTERIUM AS THE CAUSE OF RECURRENT PNEUMOTHORAX

Determining the risk of developing EBV­-associated lymphoma in HIV-­infected patients

Objective — to increase the efficiency of predicting the development of EBV-associated lymphomas in patients with HIV infection.
 Materials and methods. In order to improve the prediction of the development of Epstein—Barr associated lymphomas in HIV-infected patients, a comparative analysis of various indicators (clinical-epidemiological, laboratory, serological, etc.) was carried out in 57 HIV patients who had clinical and laboratory confirmation of the presence of co-infection with the Epstein—Barr.Of the 57 patients, manifestations of primary CNS lymphoma were registered in 7 patients (12.3 %), another 1 patient was diagnosed with B-cell large cell lymphoma of the frontal sinus, centroblastic variant (1.8 %), in 1 patient — Burkitt’s lymphoma with lesions of the cervical lymph nodes (1.8 %). To clarify the main trends in the development of lymphomas in patients with HIV and EBV coinfection, a detailed analysis was carried out in two groups: the main group consisted of 9 patients with lymphomas, the remaining 48 patients without detected neoplasms formed the comparison group.
 Results and discussion. To improve the efficiency of the forecast, multifactorial logistic regressions were constructed, taking into account not only the independent, but also the joint influence of the considered risk factors. To do this, the sum of the scores for each observation was calculated using the corresponding predictive coefficient rank qualification created using the Wald analysis. Based on a multivariate prognostic model, an algorithm was created to determine the risk of developing EBV-associated lymphomas in patients co-infected with EBV and HIV.
 Conclusions.The created algorithm for determining the risk of developing EBV-associated lymphomas in patients with HIV makes it possible to identify patients with different risks of developing lymphomas under conditions of infection with EBV and HIV, which further creates the possibility for predicting an unfavorable course of HIV infection.The proposed algorithm has a high predictive efficiency, which makes it possible to determine the risk at the individual level and lays the foundation for optimizing the diagnosis of Epstein—Barr virus infection in HIV-infected patients.

Особливості спектру мікрофлори при гнійній інфекції м’яких тканин у ВІЛ-інфікованих та принципи лікування

Проведено аналіз спектру мікрофлори при гнійній інфекції м’яких тканин у 85 ВІЛ-інфікованих пацієнтів. Спектр мікрофлори таких пацієнтів, у порівнянні з пацієнтами без ВІЛ-інфекції, характеризується суттєвою перевагою грибкової флори (12%, проти 1,1%), патогенних стафілококів (16,3%, проти 5,2%). Чутливість до антимікотиків при гнійній інфекції м’яких тканин у ВІЛ-інфікованих пацієнтів є значно нижчою, у порівнянні з пацієнтами без ВІЛ-інфекції. Враховуючи більш стійку резистентність до антимікотиків та деяких антибактеріальних препаратів, у комплексному хірургічному лікуванні гнійних ран м’яких тканин у ВІЛ-інфікованих пацієнтів необхідно використовувати ультразвукову кавітацію та V.A.C. терапію.

Risk factors for methicillin-resistant Staphylococcus aureus colonization and infection in patients with human immunodeficiency virus infection: A systematic review and meta-analysis.

ObjectiveTo investigate the potential factors affecting methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in patients with human immunodeficiency virus (HIV) infection.MethodsA systematic search of publications listed in electronic from inception up to August 2020 was conducted. A random-effects model was used to calculate odds ratio (OR) with 95% confidence interval (CI).ResultsA total of 31 studies reporting 1410 MRSA events in 17 427 patients with HIV infection were included. Previous hospitalization (OR 1.80; 95% CI 1.37, 2.36), previous antibiotic therapy (OR 2.69; 95% CI 2.09, 3.45), CD4+ count (OR 1.79; 95% CI 1.41, 2.28), Centers for Disease Control and Prevention classification of stage C (OR 2.66; 95% CI 1.80, 3.93), skin lesions (OR 2.02; 95% CI 1.15, 3.55), intravenous device use (OR 2.61; 95% CI 1.59, 4.29) and an MRSA colonization history (OR 6.30; 95% CI 2.50, 15.90) were significantly associated with an increased risk of MRSA colonization and infection. Antiretroviral therapy (OR 0.71; 95% CI 0.50, 0.99) and current antibiotic use (OR 0.13; 95% CI 0.05, 0.32) were significantly associated with a reduced risk of MRSA colonization and infection.ConclusionMRSA colonization and infection in HIV-infected patients is associated with a number of risk factors.

Deaths related to Chagas disease and HIV/AIDS coinfection in Brazil: a nationwide population-based analysis.

Trypanosoma cruzi/HIV coinfection has been described as a relevant clinical event and an emerging public health problem. Here, we describe the epidemiological patterns of deaths related to Chagas disease and HIV/AIDS coinfection in Brazil from 2000 to 2019. We performed a nationwide population-based study using mortality data obtained from the Brazilian Mortality Information System. We included all deaths recorded in Brazil from 2000 to 2019 in which Chagas disease and HIV/AIDS were mentioned on the same death certificate, either as underlying or as associated causes of death. Chagas disease and HIV/AIDS were mentioned on 196/22 663 092 death certificates. HIV/AIDS was the underlying cause in 58.2% (114/196) of deaths and Chagas disease in 33.2% (65/196). The average annual mortality rate was 0.05 deaths/1 000 000 inhabitants (95% CI 0.03 to 0.09). The highest death rates were found among males, those aged 60-69 y, Afro-Brazilians, those with 1-3 y of schooling/study and residents in Chagas disease-endemic regions/states. Respiratory, infectious/parasitic and cardiovascular diseases/disorders were the associated causes of death most commonly mentioned. Mortality due to Chagas disease and HIV/AIDS coinfection may be largely underestimated in Brazil. Our data further reinforce the importance of screening for T. cruzi infection in HIV-infected patients from Chagas disease-endemic areas. Appropriate clinical management should be ensured for Chagas disease and HIV coinfected patients.

Ezrin Peptide Therapy from HIV to COVID: Inhibition of Inflammation and Amplification of Adaptive Anti-Viral Immunity.

Human Ezrin Peptides (HEPs) are inhibitors of expression of IL-6 and other inflammatory cytokines, amplifiers of adaptive B cell and T cell immunity and enhancers of tissue repair. The mutation stable C-terminus of HIV gp120, mimics 69% of the “Hep-receptor”, a zipped α-helical structure in the middle of the α domain of human ezrin protein. Synthetic peptides homologous to the Hep-receptor of ezrin of five to fourteen amino acids, activate anti-viral immunity against a wide range of viruses (HIV, HCV, herpes, HPV, influenza and other human respiratory viruses). Human Ezrin Peptide One (HEP1) TEKKRRETVEREKE (brand name Gepon, registered for human use in Russia from 2001) is a successful treatment for opportunistic infections in HIV-infected patients. That treats HEP1and prevents mucosal candidiasis, herpes zoster outbreaks and infection-induced chronic diarrhea. There are clinical publications in Russian on the successful treatments of chronic recurrent vaginal candidiasis, acute and chronic enterocolitis and dysbacteriosis, which are accompanied by normalization of the mucosal microbiome, and the decline or disappearance of inflammation. HEP1 is also an effective treatment and prevention for recurrent inflammation and ulceration in the stomach, duodenum and colon. HEP1 and RepG3 GEKKRRETVEREGG (a derivative of HEP1) have been used successfully as an inhaled spray peptide solution to treat a small number of human volunteers with mild-to-moderate COVID, resulting from SARS-CoV-2 infection, based on earlier successes in treating acute viral respiratory disease with inflammatory complications. Ezrin peptides seem to correct a dysregulation of innate immune responses to SARS-CoV-2. They are also adjuvants of B cell adaptive immunity and increase antibody titres, resulting in protection from lethal virus infection of mice. In a clinical study in Moscow, orally administered HEP1 was shown to enhance antibody-titres produced in response to hepatitis-B vaccination. These very preliminary but promising results with ezrin peptide treatment of COVID must be replicated in large-scale randomised placebo controlled clinical studies, to be verified.

The development and validation of a diagnostic scoring system to differentiate pulmonary tuberculosis from non-tuberculosis pulmonary infections in HIV-infected patients with severe immune suppression

BackgroundIt remains challenging to differentiate tuberculosis (TB) from non-TB pulmonary infections in HIV-infected patients. Herein, we developed a scoring system aimed to rapidly determine the likelihood of TB or non-TB pathology in HIV-infected patients presenting with pulmonary infections.MethodsWe collected and collated data of hospitalized HIV-infected patients with pulmonary infections, followed by univariate and multivariate data analyses to determine risk variables that were significantly different between HIV/TB patients and HIV/non-TB patients. Subsequently, a regression coefficient was calculated for each variable, and a score was assigned to each variable in line with its regression coefficient. The sum of the scores for each variable in our scoring model was used to predict the likelihood of TB or non-TB pulmonary infection in each patient. Finally, we tested the diagnostic accuracy of the scoring system in our retrospective cohort, as well as in a prospective cohort.ResultsA total of 598 HIV-infected patients were enrolled in our retrospective cohort, among whom 288 had TB and 310 had non-TB pulmonary infections. Eight variables, including fever, highest body temperature, erythrocyte sedimentation rate (ESR), cervical lymphadenopathy, hilar and/or mediastinum lymphadenopathy, pulmonary cavitation, pleural effusion, and miliary nodules, were found to be mathematically significantly different via univariate analysis and multivariate logistic regression analysis. After regression coefficient calculation followed by score assignment, a receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) was calculated to be 0.902. When the total score for a patient is > 12, the sensitivity and specificity for TB prediction using our scoring system were 76.4% and 87.7% respectively in the retrospective cohort, and its diagnostic accuracy was 82.7% in the prospective cohort.ConclusionsOur results demonstrate that our proposed diagnostic scoring system could be helpful in differentiating pulmonary TB from non-TB pulmonary infections in HIV-infected patients.

Neuromeningeal cryptococcosis in HIV-infected patients in Lubumbashi, Democratic Republic of the Congo

Introduction: Neuromeningeal cryptococcosis (NMC) is a severe and fatal opportunistic infection. Lethality is higher in the absence of treatment, especially in HIV co-infection. The objective of the present study was to determine the prevalence, epidemiological, clinical, biological, and therapeutic features as well as the outcome of NMC in HIV-infected patients. Methods: This is a retrospective study of 108 cases of NMC diagnosed in HIV-infected patients. Data were collected over 36 months (from January 2015 to December 2017) at the HIV/AIDS Center of Excellence in Lubumbashi (Democratic Republic of the Congo). Results: The overall prevalence of NMC is 2.5%. The mean age of the patients was 41.5±13.1 years, with 72.2% aged less than 50 years. The main clinical symptomatology was headache (100%) and fever (100%). The main cytochemical CSF abnormalities were hyperproteinorachia (91.9%), hypoglycorachia (94%) and hyper-lymphocytosis (98.2%). The mean CD4 count was 168.7±137.1/mm3. All patients were treated with fluconazole. The overall lethality was 43.5%. Conclusion: NMC is a serious opportunistic infection in HIV-infected patients, and the case fatality rate remains unacceptable. Management of NMC in HIV-positive patients requires early diagnosis, increased access to antiretrovirals and prompt initiation of appropriate treatment.

Memory-like innate immunity following infection with Pneumocystis murina

Abstract Pneumocystis pneumonia (PCP) continues to be a life-threatening infection in HIV-infected patients, renal transplant patients, and other immunocompromised individuals. Dendritic cells are key antigen presenters to CD4+ T cells, which are critical to controlling Pneumocystis infection. b-1,3 glucans are found in the cell wall of the cyst form of Pneumocystis and are a known activator of innate immune cells via the dectin-1 receptor. b-glucans derived from other fungi have been shown to induce an enhanced “memory-like” immune response, termed trained immunity, in innate cells, including monocytes, macrophages, and dendritic cells. Therefore, we explored if Pneumocystis infection can induce an enhanced innate immune response in mice following exposure via a natural route of infection. We conducted mixing experiments using purified CD4+ T cells and dendritic cells from unexposed C57BL/6 mice and mice that spontaneously cleared infection. We found that CD4+ T cells from naïve mice exhibited a significantly greater proliferation after 5-day cultures when a crude Pneumocystis antigen was presented by CD11c+ dendritic cells from exposed mice compared to unexposed mice. In support of this, CD4+ T cells from C57BL/6 mice that were immunized with Freund’s adjuvant alone exhibited significantly greater proliferation when a crude Pneumocystis antigen was presented by either CD11c+ dendritic cells or CD11b+macrophages from mice immunized with Pneumocystis antigen mixed with Freund’s adjuvant vs. adjuvant alone. These results suggest that Pneumocystis infection stimulates a memory-like innate immune response which may be important in controlling subsequent exposure to Pneumocystis, as well as exposure to other pulmonary pathogens.

Clinical Characteristics and Outcome of Bloodstream Infections in HIV-Infected Patients with Cancer and Febrile Neutropenia: A Case-Control Study.

IntroductionWe aimed to compare the clinical characteristics and outcomes of bloodstream infections (BSI) in cancer patients presenting febrile neutropenia with and without HIV infection, and analyze the prognostic factors for mortality.MethodsBSI episodes in febrile neutropenic patients following chemotherapy were prospectively collected (1997–2018). A case (HIV-infected)–control (non-HIV-infected) sub-analysis was performed (1:2 ratio), matching patients by age, gender, baseline disease, and etiological microorganism.ResultsFrom 1755 BSI episodes in neutropenic cancer patients, 60 (3.4%) occurred in those with HIV. HIV characteristics: 51.7% were men who have sex with men; 58.3% had < 200 CD4; 51.7% had a detectable HIV-1 RNA viral load before the BSI episode; 70.0% met AIDS-defining criteria; and 93.3% were on antiretroviral therapy, with a protease inhibitor-based regimen being the most common (53.0%). HIV-infected patients were younger, more frequently male and more commonly presenting chronic liver disease (p < 0.001 for all). BSI due to Enterococcus spp. was significantly more frequent among patients with HIV (p = 0.017) with no differences in other pathogens. HIV-infected patients with cancer presented with shock more frequently (p = 0.014) and had higher mortality (31.7% vs. 18.1%, p = 0.008). In the case–control analysis, cases (HIV-infected) had chronic liver disease (p = 0.003) more frequently, whereas acute leukemia (p = 0.013) and hematopoietic stem-cell transplant (p = 0.023) were more common among controls. There was a non-significant trend for cases to have higher mortality (p = 0.084). However, in multivariate analysis, HIV infection was not associated with mortality (p = 0.196).ConclusionHIV-infected patients with cancer developing febrile neutropenia and BSI have different epidemiological and clinical profiles, and experience higher mortality. However, HIV infection by itself was not associated with mortality.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40121-021-00445-3.

Epidemiology and influencing factors of human immunodeficiency virus and hepatitis B virus co-infected patients in Beijing

Objective: To analyze the epidemiological characteristics of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) co-infected patients in Beijing and investigate the associated factors. Methods: The clinical data of patients with HIV infection who were treated in HIV/AIDS designated hospitals (Peking Union Medical College Hospital, Beijing Ditan Hospital and Beijing Youan Hospital) were retrospectively analyzed. Results: A total of 11 572 patients were finally included in the study, among whom 532 patients (4.6%) were co-infected with HIV and HBV. Most of the co-infected patients were young male adults (28~48 years old), accounting for 85.9%. The main transmission route was homosexual behavior (74.8%). There were 87.4% co-infected patients treated with two anti-HBV drugs, including lamivudine (3TC) and tenofovir (TDF). From 2013 to 2018, the annual prevalence of HIV and HBV co-infection decreased gradually, with the rate of 6.37%, 4.55%, 3.92%, 4.68%, 4.24% and 2.74%, respectively. In our study, The main influencing factors of HIV and HBV co-infection were age older than 28 years old versus<28 years old (OR=2.807, 95%CI 1.241-6.345) and marriage status (married versus unmarried, OR=1.259, 95%CI 1.004-1.579). Conclusions: The proportion of HBV infection in HIV-infected patients is 4.60% (532) in our cohort. From 2013 to 2018, the prevalence of HIV and HBV co-infection in Beijing shows a decreasing trend. The risk of co-infection is higher in married young adults (28~48 years old).

Treatment of human papillomavirus infection in HIV-infected patients

The first reports about HIV (human immunodeficiency virus) were appeared to the 1980s. By 2017 more than 37 million people were living with HIV. Human papilloma virus (HPV) is universally spread, with some estimates showing that about 1% of the sexually active population having genital warts. Human papilloma virus (HPV)-induced infection frequently accompanies the clinical course of HIV and can manifest itself in a full spectrum of clinical-pathologic forms ranging from common warts to malignant neoplasia. Due to the widespread use of antiretroviral therapy, the number of patients with a combined infection (HIV+HPV) is steadily increasing. Here we review current clinical treatment options for HPV manifestations. High-dose antiretroviral therapy does not impede HPV treatment, and can even improve its efficacy in some cases. The topical administration of imiquimod, an immune response modifier, is an effective conservative treatment in HIV-infected patients with HPV. The immunomodulation therapy of imiquimod can serve as an effective alternative of aggressive chemical and mechanical procedures. Maximum efficacy with the lowest replaces rates may be expected from combined use of mechanical ablation methods with a subsequent follow up treatment with imiqui-mod. The best therapeutic result is expected in HIV-positive patients who are received high-dose antiretroviral treatment. The advantages of Vartocid, the modified Russian equivalent of the generic imiquimod.

Gastrointestinal disseminated histoplasmosis in HIV-infected patients: A descriptive and comparative study.

Disseminated histoplasmosis is one the main AIDS-defining opportunistic infections in HIV-infected patients, notably in Latin America. The non-specific and proteiform clinical presentation leads to diagnostic delays that may lead to fatal outcomes. This retrospective multicentric study aimed to describe the frequency and manifestations of gastrointestinal histoplasmosis in French Guiana, and to compare patients with disseminated histoplasmosis with or without gastrointestinal involvement.Between January 1, 1981 and October 1, 2014 co-infections with HIV and histoplasmosis were enrolled. Inclusion criteria were: age >18 years, confirmed HIV infection; first proven episode of histoplasmosis.Among 349 cases of disseminated histoplasmosis, 245 (70%) had a gastrointestinal presentation. Half of patients with gastrointestinal signs had abdominal pain or diarrhea, mostly watery. Half of patients with abdominal pain had diarrhea (63/124) and half of those with diarrhea (63/123) had abdominal pain. A significant proportion of patients also had hepatomegaly and, to a lesser degree, splenomegaly. After adjusting for potential confounding, the presence of lymphadenopathies >2cm (AOR = 0.2, IC95 = 0.04–0.7, P = 0.01), Haitian origin (AOR = 0.04, IC95 = 0.004–0.4, P = 0.006) were associated with a lower prevalence of gastrointestinal signs and positive gastrointestinal presence of H. capsulatum. Persons with a gastrointestinal H. capsulatum were more likely to have a decreased prothrombin time, lower ferritin, lower liver enzymes, and lower concentrations of LDH than those without gastrointestinal signs and symptoms. They also had a shorter interval between symptoms onset and diagnosis. Patients with a positive gastrointestinal identification of H. capsulatum were less likely to die at 1 month than those without a gastrointestinal presentation (respectively, 4.6% vs 18.5%, P = 0.01).Subacute or chronic gastrointestinal presentations are very frequent during disseminated histoplasmosis, they seem less severe, and should lead to suspect the diagnosis in endemic areas. There were populational or geographic differences in the frequency of gastrointestinal manifestations that could not be explained.

A Follow-up Study to Evaluate Lipids as Cost-Effective Markers in HIV-Infected Patients on Antiretroviral Therapy

Background: Human immunodeficiency virus (HIV) infection per se and antiretroviral therapy (ART) both are associated with dyslipidemias, one of the important risk factors in the development of premature atherosclerosis and coronary artery disease. Certain classes of highly active antiretroviral therapy (HAART), especially protease inhibitors, are more frequently associated with dyslipidemia. The objectives of this study were to evaluate and compare lipid profile – total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglyceride in HIV patients before and after starting ART and also to correlate lipid profile and CD4 counts in HIV infection, thus evaluating the feasibility of using lipid profile to monitor the progression of infection in HIV-infected patients as an adjunct to CD4 counts in resource-limited settings. Methods: Paired samples of 100 newly diagnosed HIV patients were taken before and after treatment with HAART. CD4 cell counts and lipid parameters measured and compared using paired 't'-test. Each of the lipid parameter correlated with CD4 cell count. Results: Significant increase was seen in the levels of TC and HDL-C (P < 0.05) with treatment. CD4 cell count also showed a significant increase (P < 0.05) with therapy. HDL-C levels correlated significantly with CD4 cell counts in pretreatment group (r = 0.23, P = 0.020, 95% C.I.). Conclusion: Combination of zidovudine, lamivudine, and nevirapine is associated with significant increase in HDL-C. HDL-C levels are a good indicator of disease severity in HIV-infected patients before starting the therapy.

Epidemiology of Infections Caused by Seasonal Human Coronavirus in Hospitalized Adults with HIV Over a 5-year Period in Mexico City

Although the incidence of HIV-associated lung infections has changed due to the use of antiretrovirals, and the knowledge of the contributions of respiratory viruses, including subtypes of seasonal human coronavirus (HCoV) has increased, studies to analyze and compare prognosis and risk factors between HIV-positive and negative individuals with HCoV respiratory infections are scarce. Patients with HIV are at a higher risk of getting infected with various pathogens, including viruses, therefore, it is important to comprehend the epidemiology of these infections. This study aimed to expose the epidemiological aspects of HCoV infections, comparing HIV-positive and negative patients. This study used a retrospective design and the data analyzed were collected from November 2013 to March 2018, a comparison of characteristics between patients with HIV and without HIV infected with HVoC using χ2, Student's T or Mann-Whitney U tests was performed. The detection of coronavirus species by the Luminex system in patients with HIV showed that HCoV-NL63 was the most frequent, with a prevalence of 45.5%, followed by HCoV-OC43 and HCoV- 22E9, with 36% and 18.2%, respectively. Overall, the HCoV-OC43 species was detected more frequently and winter was the season when more cases occurred. Pneumonia was the most frequent clinical manifestation and the main coinfection was due to Pneumocystis jirovecii. Seasonal human coronaviruses are an important cause of infection in HIV-infected patients, resulting in several clinical repercussions. Further studies are necessary to determine the implications of HCoV in these patients, as well as the epidemiological significance of HCoV infections in HIV-positive individuals in Mexico and throughout the globe.