HIV-infected Patients Research Articles

ПЕРИКАРДИТ, АССОЦИИРОВАННЫЙ С ВИЧ-ИНФЕКЦИЕЙ И ТУБЕРКУЛЕЗОМ

Introduction. HIV infection, despite the measures taken, continues to spread throughout the world. Unfavorable course of diseases is often determined by some concomitant pathologies. Among HIV-infected patients, tuberculosis is the most common disease forming the comorbid condition named “TB/HIV” that reaches more than a half of all the cases of newly diagnosed tuberculosis in some regions of Russia. In recent years, due to the increase in the HIV- infected patients’ life expectancy based on antiretroviral therapy, cardiovascular diseases, such as primarily infectious pericarditis, are gradually beginning to hold a significant place. Aim: To select and analyze publications dealing with HIV- and tuberculosis-associated infectious pericarditis. Materials and Methods. A systematic search was conducted for publications that examined possible associations between pericardial damage, HIV infection and tuberculosis. A search of publications was carried out in the electronic databases PubMed, www.pubmed.gov; MEDLINE, www.ncbi. nlm.nih.gov; and Russian scientific database eLibrary, https://www.elibrary.ru. Preference was given to meta-analyses or systematic reviews, and studies with duplicate materials were excluded from the analysis. Results and Discussion. Publications on the epidemiology of infectious pericarditis associated with HIV infection and tuberculosis in the world and Russia are presented by authors from different countries; both the human immunodeficiency virus and mycobacterium tuberculosis are important for the development of pericarditis. Tuberculous pericarditis, being a rare manifestation of tuberculosis, usually reflects the severity of the disease and an unfavorable prognosis. In cases of unexplained pericardial effusion, it is advisable to include testing for HIV infection in the differential diagnosis plan. Conclusions. Diagnosis of pericarditis requires a multidisciplinary approach; late diagnosis has an unfavorable prognosis.

IJCM_288A: Factors responsible for death among HIV infected patients registered in ART Centre Jabalpur, Madhya Pradesh.

Background: Factors responsible for death in HIV infected population are necessary to devise disease specific preventive interventions at both state and national level HIV programs. This study examines the factors responsible for death among HIV-infected individuals registered in Anti-Retro-viral Therapy (ART) center Jabalpur, Madhya Pradesh. Objectives: 1. To understand the trends of HIV deaths in last 6 years in Jabalpur District. 2. To understands the factors responsible for deaths among registered HIV positive patients in ART Centre of Jabalpur District. Methodology: A retrospective chart review of factors responsible for death was undertaken among HIV-infected patients who were treated between January 2016 and December 2021 at ART Center Jabalpur. Results: Among total of 83 sample cases registered from January 2016 to December 2021, 86.7% of those who died were males. Mean duration of survival after initiation of treatment is 17 months. 49.4% of the cases falls under the age group of 31-45 years. 75.9% of the cases contracted the virus through sexual mode of transmission. 56.6% of the cases had opportunistic infections. Tuberculosis is (32.5%) is the leading opportunistic infections and 28.9% of cases had CD4 count in the range of 50-199 cells/mm. Conclusion: Tuberculosis has remained the leading factor responsible for deaths among the HIV patients on ART. Deaths were significantly associated with patient’s CD4 count at the time of diagnosis and the presence of opportunistic infections during treatment.

Prevalence of syphilis and associated risk factors among human immunodeficiency virus-infected patients at the Lagos University Teaching Hospital Nigeria: A cross-sectional study

Background: Worldwide, there was an estimated 7.1 million new cases of syphilis in 2020, and most of the infections were found in developing countries like Nigeria. The objective of the study was to determine the prevalence and risk factors for syphilis among human immunodeficiency virus (HIV)-infected patients in Lagos. Methods: A cross-sectional study was conducted in an HIV Clinic in Lagos, Nigeria, from April to June 2017 and 385 HIV-infected adult participants 18 years and above were recruited into the study. Structured questionnaires were used to collect data on sociodemographic and risk factors for syphilis. Blood samples were collected from all participants and tested for syphilis using rapid plasma reagin and Treponema pallidum hemagglutination assay test kits. Data were analyzed using SPSS (IBM) V. 20. Bivariate analysis was carried out using Chi-square, Fisher’s exact test, and Student’s t-test on sociodemographic and risk behavioral factors. Multivariable logistic regression analysis was performed with variables that were significantly associated with syphilis in bivariate analysis. A P < 0.05 was considered to be statistically significant. Results: Out of 388 HIV-infected patients recruited into the study, 262 (67.5%) were female. The mean age was 43.6 ± 10.1 years, and 137 (35.3%) of them were in the age group of 41–50 years. The prevalence of syphilis in HIV-infected patients was 1.8%. The prevalence of syphilis was significantly higher in males (4.8%) than females (0.4%). The prevalence of syphilis was higher in those with no education or primary school education, and multiple sexual partners were statistically significant in the bivariate analysis but not in the multivariate analysis. Male gender was the only independent risk factor for syphilis, with an odds ratio of 11.79 (95% confidence interval [1.26–106.5], P = 0.03) in multivariate analysis. Conclusion: The prevalence of syphilis in this study was lower than previous work done in other HIV-positive cohorts in Nigeria. Males were more affected significantly in this study. Routine screening and testing for syphilis should be integrated into HIV care, especially in males.

Postmortem for Intensified Missed Tuberculosis Case Finding in High Human Immunodeficiency Virus and Tuberculosis-burdened Settings in Sub-Saharan Africa among Adults’ Population: Systematic Review and Meta-analysis

Tuberculosis (TB) is the leading infectious cause of mortality in sub-Saharan Africa (SSA); the high prevalence of TB in this region is due to human immunodeficiency virus (HIV)-coinfection. Despite the advent of modalities to diagnose TB, undiagnosed TB-related deaths among HIV-infected patients remain significantly high. This systematic review aims at characterizing missed TB cases from postmortem studies. This review informs on the burden of TB missed diagnosis and highlights the need of improving TB case-finding strategies, especially among the high-risk groups and early TB therapy initiation to keeping in with the World Health Organization’s end TB strategy. We searched PubMed, Cochrane, Web of Science, and African journals online for studies that looked into missed TB cases following postmortem using the following key terms: postmortem, TB diagnosis, and HIV; we included cross-sectional and cohorts from 1980 in the English language that were carried out in SSA among adults’ population. Authors used the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for reporting, the quality of the included studies was assessed using the Newcastle–Ottawa Scale for observational studies, and STATA 17.0 software was used for analysis. This study was registered in the International Prospective Register of Systematic Reviews with registration number CRD42024507515. The combined prevalence of postmortem missed TB diagnosis among the 6025 participants was 27.13% (95% confidence interval [CI] =14.52–41.89), with a high level of heterogeneity at 98.65% (P < 0.001). The prevalence varied significantly across the included studies, ranging from 1.21% (95% CI = 0.93–1.59) in the general population to 66.67% (95% CI = 50.98–79.37) in people living with HIV (PLWHIV). This current literature suggests that SSA is a region with a high prevalence of missed TB cases but with significant variations between countries. In addition, this study confirms a high number of missed TB infections within the PLWHIV. These results highlight the immediate need for targeted screening and diagnosis strategies and relevant policies.

Cryptococcal meningitis presenting as simple headache in early adulthood HIV-infected patient: A case report

Cryptococcal meningitis is a rare disease caused by Cryptococcus neoformans or Cryptococcus gatii as the fungal pathogen in humans. The disease is highly prevalence in people living with human immunodeficiency virus (HIV) and is the major cause of mortality in an immunocompromised individual. This life-threatening disease does not often occur with specific signs and symptoms. We reported a case of an early adulthood HIV-infected patient with a mild headache and low-grade fever. There were no altered mental status or other significant specific manifestations. Blood examination, chest radiograph, and computed tomography scan revealed no significant results. C. neoformans were isolated from a culture of the cerebrospinal fluid specimen as the conventional gold standard examination for cryptococcal meningitis. A positive result was confirmed in the India ink staining preparation. The patient was treated with fluconazole monotherapy for the induction and consolidation phase and showed a positive disease progression during observations.

Re-signifying HIV through exercise: from death sentence stigma to healthy self-perception

ABSTRACT Despite HIV being considered a chronic disease and the benefits that exercise interventions can bring to HIV-infected patients, the application of physical activity is currently low. Some qualitative studies have been conducted; however, it is currently little known about the meaning of the experience of exercising in people with HIV. This hermeneutic research used 21 in-depth, semi-structured interviews with patients with this condition. The analysis was based on a grounded Theory methodology, which is theoretically supported by symbolic interactionism. It was possible to advance in re-signifying HIV from a social stigma context. This process, through exercise and social, family and medical support, comes from the breaking of individual and collective perception paradigms. Particularly, exercise changes the perspective from a HIV-infected person on the verge of death to a healthy, active and functional individual with personal goals. Thus, by contributing to functionality and health recovery, exercise re-signifies life. Moreover, commitment to physical activity goals is influenced by inner tensions that can hinder or encourage this habit and demand further research. HIV infection shifts from being a death sentence to a healthy self-perception beyond the diagnosis.

Active tuberculosis incidence among treatment failure experienced patients in North Wollow Zone: A multicenter historical cohort.

In Ethiopia, tuberculosis (TB) is a significant cause of death among individuals living with HIV, especially in resource-limited areas and those who have experienced treatment failure. However, there is the paucity of data regarding TB among treatment failures experienced people living with HIV. This study aimed to estimate the rate and identify predictors of tuberculosis among patients who received second-line treatment in North Wollo, Northeast Ethiopia. A retrospective follow-up study was conducted on 474 HIV-infected patients who experienced treatment failure. The study period ranged from January 2015 to September 30, 2021. The incidence of TB was assessed using a Cox proportional hazard regression model, after ensuring that all assumptions were met. Factors associated with active TB were determined by analyzing adjusted hazard ratios and 95% confidence intervals. In a study of 474 HIV-positive patients on second-line antiretroviral treatment, we found an incidence rate of 3.6% with 17 new cases of TB observed over 4412.4 persons per year (PPY). The overall incidence density rate was estimated to be 0.39 cases per 100 PPY (95% CI: 0.239-0.618). Regarding the occurrence of active TB in second-line patients, WHO clinical treatment stage (T3 and T4), missed isoniazid preventive therapy had a significantly higher risk (AHR: 13.225, 95% CI: 2.894-60.434, p = 0.001), while being married was associated with a lower risk (AHR: 0.203, 95% CI: 0.045-0.907, p = 0.001). A high incidence of active TB was observed shortly after initiating second-line antiretroviral treatment. Factors such as being in the WHO clinical treatment stage (T3 and T4) and marital status were determinants for active TB. To improve overall survival rates, it is vital to enhance early TB screening and implement effective isoniazid preventive therapy.

PATHOMORPHOLOGICAL FEATURES OF CRYPTOCOCCOSIS OF THE LUNGS AND CNS IN CASE OF HIV-INFECTION/AIDS

Background. Cryptococcosis is an important opportunistic infection that most commonly presents with meningitis or meningoencephalitis, especially in HIV-infected patients. Pulmonary disease is less common but is probably underdiagnosed because of the nonspecific nature of symptoms or the increased frequency of other pulmonary opportunistic infections.
 Aim: to investigate the pathomorphological features of cryptococcal lesions of the lungs and central nervous system in case of HIV infection/AIDS.
 Materials and methods. Pathomorphological examination was carried out on the autopsy material. HIV infection was diagnosed in the patients during life with serological verification and the patients were registered at the AIDS Center. Ziehl-Neelsen staining, and PAS reaction were used to detect cryptococci in lung and brain tissue. Standard histological preparations were examined under a microscope to clarify or establish the following data: the presence of cryptococci (both encapsulated and non-encapsulated), their localization and density, the presence of an inflammatory infiltrate and its severity.
 Results. The histopathology of lung lesions in cryptococcosis is characterized by the presence of granulomas with numerous cryptococci and a lympho-macrophagic reaction with multinucleated cells of the Langhans type. The total number of cryptococci in the field of vision (x400) is moderate to significant, their dissemination is uneven, localization is in the interstitium and among the inflammatory infiltrate, cryptococci are round in shape, including encapsulated, some deformed. Cryptococcosis of the brain in case of HIV infection/AIDS was characterized by the accumulation of numerous cryptococci in the expanded perivascular space and among the inflammatory infiltrate in meninges of the brain and cerebellum.
 Conclusion. Dissemination of cryptococcosis in the form of meningitis and meningoencephalitis is a prognostically unfavorable sign of the course of the disease. Cryptococcal lung disease was characterized by a polymorphic histological picture with the presence of an interstitial infiltrate and granuloma with multinucleated cells of the Langhans type and numerous cryptococci.

Expression of Concern: Actinomyces ihumii,” a new bacterial species isolated from the digestive microbiota of a HIV-infected patient

Expression of Concern: Actinomyces ihumii,” a new bacterial species isolated from the digestive microbiota of a HIV-infected patient

Predictors of antiretroviral treatment failure to the first line therapy: a cross-sectional study among Iranian HIV-positive adults

BackgroundHIV virological failure is one of the main problems in HIV-infected patients, and identifying the main predictors of such treatment failure may help in combating HIV/AIDS.MethodologyThis cross-sectional study included 1800 HIV-infected patients with either virological failure or treatment response. HIV viral load, CD4 count, and other tests were performed. Statistical analysis was used to determine the predictors of virological failure.ResultsClinical stage, treatment with reverse transcriptase inhibitors (RTIs), under therapy for three years or more, suboptimal adherence to antiretroviral treatment (ART), age > 40 years, CD4 count < 200 cells/mm3, unemployment, being infected through sex, and the presence of symptoms were the predominant risk factors for virological failure. In addition, 55% of patients who experienced virological failure failed to experience immunological and/or clinical failure.ConclusionAs the first study in southern Iran and the second in Iran, Iranian policymakers should focus on intensive counseling and adherence support and emphasize more effective treatment regimens such as protease and integrase inhibitors (PIs and INTIs), to increase the chance of a treatment response to ART. The accuracy of identifying clinical and immunological criteria in resource-limited settings is not promising. The present findings can be used to determine effective measures to control HIV treatment failure and design efficient strategies for the ambitious 95–95–95 plan.

Pathological proliferation: a potential mechanism for poor CD4+ T cell recovery in people living with HIV.

People living with HIV (PLWH) fail to achieve normalization of CD4+ T cell counts and function, especially in immunological non-responders (INRs). The frequencies of Ki67+CD4+ T cells were inversely associated with CD4+ T cell counts in HIV infected patients. Early ART did not normalize CD4+ T cell proliferation. However, the features of the abnormal proliferation CD4+ T cell in INRs are far from known. PLWH were divided into INRs (n= 16) and immunological responders (IRs, n= 53) groups. Mass cytometry was applied to peripheral blood T cells to profile the immune cells and liquid chip technique was used to measure plasma levels of cytokines and chemokines. Correlation analyses were conducted to evaluate associations between the degree of CD4+ T cell proliferation and immune function. The percentage of Ki67+ CD4+ T cells were significant higher in INRs, and we defined these cells with significant higher level of Ki67, as over-proliferating cells. No significant difference of markers' expression (HLA-DR, CD38, CD57, PD-1, PD-L1, CD107a, perforin) was found between INRs and IRs. Compared with naïve CD4+ T cells in INRs, Ki67+ CD4+ T cells exhibited lower levels of CD57 and CD38. Whereas Ki67+ T cells exhibited higher levels of CD38 and CD57 and activation compared with differentiated mature central memory CD4+ T cells and effector memory CD4+ T cells. Ki67+ cells did not show higher levels of senescence and activation compared to certain Ki67- CD4+ central memory T cells in IRs. Furthermore, Ki67+ CD4+ Tcm cells exhibited positive correlations with pro-inflammatory cytokines. We proposed and validated the hypothesis of "pathological proliferation" in INRs: excessive proliferation of CD4+ T cells in INRs may be accompanied by aberrant activation, senescence and loss of immune function. Eventually, such over-proliferating but poor-quality cells in INRs result in incomplete recovery of both CD4+ T cell counts and function. An intervention that enhancing the proliferative capacity or functional ability or both of CD4+ T cell in INRs might therefore be beneficial.

Treatment with bulevirtide in HIV-infected patients with chronic hepatitis D: ANRS HD EP01 BuleDelta and compassionate cohort

Background and AimsIn France, Bulevirtide (BLV) was available in September 2019 through an early access program to treat patients with hepatitis Delta virus (HDV). The aim of this analysis was to evaluate the efficacy and safety of BLV in HIV patients with HDV coinfection. Patients and methodsPatients received BLV 2 mg +/- pegylated interferon (pegIFNα) according to the physician’s decision. The primary endpoint (per-protocol analysis) was the virological response rate at week 48, defined as the proportion of patients with undetectable serum HDV-RNA or HDV-RNA decline > 2 log10 IU/mL from baseline. ResultsCharacteristics of the 38 patients were as follow: 28 male, mean age 47.7 years, mean baseline HDV-RNA viral load 5.7 ± 1.2 log10 IU/ml. Median HIV viral load and mean CD4 count were 32 (30 - 65) cp/ml and 566 ± 307/mm3, respectively. Eight patients stopped treatment before week 48. At W48, 10 of 19 patients (52.6%) in the 2 mg BLV group, and 5 of 7 patients (71.4%) in the 2 mg BLV + pegIFNα group had reached virological response (no HDV-RNA available in 4 patients). At W48, 7/19 patients in the 2 mg BLV group, and 3/6 patients in the 2 mg BLV + pegIFNα group had combined response (virological response and normal ALT level). ConclusionAdults living with HIV coinfected with HDV can be treated by BLV with a virological response in more than 50% of patients. The combination of BLV and pegIFNα showed a strong virological response. IMPACT AND IMPLICATIONS• Bulevirtide is the only EMA-approved drug for HDV treatment and we showed that it can be used in adults living with HIV, with an overall good tolerability.• Bulevirtide induces a virologic response in more than 50% of patients suggesting that Bulevirtide should be considered as a first-line therapy in this specific population.• Bulevirtide in combination with pegIFNα could be used in patients without pegIFNα contra-indication.• No specific drug-drug interaction is reported.

Chronic Viral Infection Compromises the Quality of Circulating Mucosal-Associated Invariant T Cells and Follicular T Helper Cells via Expression of Inhibitory Receptors.

Chronic viral infection results in impaired immune responses rendering viral persistence. Here, we compared the quality of T-cell responses among chronic hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV)-infected individuals by examining the levels of expression of selected immune activation and exhaustion molecules on circulating MAIT cells and Tfh cells. Cytokines were measured using a commercial Bio-plex Pro Human Cytokine Grp I Panel 17-plex kit (BioRad, Hercules, CA, USA). Inflammation was assessed by measuring an array of plasma cytokines, and phenotypic alterations in CD4+ T cells including circulating Tfh cells, CD8+ T cells, and TCR iVα7.2+ MAIT cells in chronic HBV, HCV, and HIV-infected patients and healthy controls. The cells were characterized based on markers pertaining to immune activation (CD69, ICOS, and CD27) proliferation (Ki67), cytokine production (TNF-α, IFN-γ) and exhaustion (PD-1). The cytokine levels and T cell phenotypes together with cell markers were correlated with surrogate markers of disease progression. The activation marker CD69 was significantly increased in CD4+hi T cells, while CD8+ MAIT cells producing IFN-γ were significantly increased in chronic HBV, HCV and HIV infections. Six cell phenotypes, viz., TNF-α+CD4+lo T cells, CD69+CD8+ T cells, CD69+CD4+ MAIT cells, PD-1+CD4+hi T cells, PD-1+CD8+ T cells, and Ki67+CD4+ MAIT cells, were independently associated with decelerating the plasma viral load (PVL). TNF-α levels showed a positive correlation with increase in cytokine levels and decrease in PVL. Chronic viral infection negatively impacts the quality of peripheral MAIT cells and Tfh cells via differential expression of both activating and inhibitory receptors.

Cerebrospinal Fluid Viral Escape on Highly Active Antiretroviral Therapy: Analysis from Single Tertiary Care Centre.

HIV-infected individuals receiving regular antiretroviral therapy (ART) can present with a high viral load in cerebrospinal fluid (CSF) at times when it is suppressed in blood. This study presents data of HIV-infected patients who had undetectable or low plasma viral load in blood but presented with neurological signs and symptoms and were diagnosed to have CSF HIV viral escape. Records were reviewed for clinical manifestations, details of opportunistic or coinfection, and HIV viral copies in plasma and CSF at time of diagnosis of CSF escape. A total of 10,200 HIV-infected individuals were registered in HIV care till December 31, 2021. Nineteen individuals (14 virologically confirmed and 5 clinically) were diagnosed with high viral copies in CSF from June 2014 to December 2021. Mean age was 41.5 ± 9.2 (median, 39.5; range, 30-62) years. Average duration of antiretroviral treatment received at the time of diagnosis of CSF escape was 10.1 years. Median plasma HIV-viral copies were 2,469.8 (undetectable to 29,418) and in CSF were 12,773.7 (n = 14, range, 1,340-48,530) copies/mL. HIV viral copies in CSF were significantly higher than in plasma at the time of presentation (p = .003). ART regimen switch was done after identification of HIV CSF escape. Seventeen patients were alive with a regular follow-up of average 35 (range 7-66) months. All had documented clinical improvement with reversal of neurological impairment after ART switch. There was one death and one lost to follow-up. Early identification and timely intervention in CSF viral escape could revert severe neurological impairment and improves treatment outcome.

Psychological features of HIV-infected patients depending on the stage of the disease

The relevance of the problem. Currently, the issue of HIV infection is acute all over the world, and the variety of HIV clinical forms is striking in its vastness and congruence with other pathologies. Among Russian and foreign publications devoted to psychological changes in patients with HIV infection, there is a lack of works on the relationship of their levels of resistance to the action of stress agents, the effectiveness of the formation of protective and compensatory behavior with differentiation by spheres (cognitive, emotional, and behavioral), and the absence or presence of alexithymia of varying degrees of severity in their personal psychological type with self-assessment of wellbeing, the severity of infection, and the presence of complications. The purpose of the study: to identify and compare the psychological characteristics of the personality of HIV-infected patients, depending on the stage of the disease. Materials and methods. We observed 150 male and female volunteers (83 and 67 patients, respectively), whose mean age was 37.5 (33.9; 42.1) years, living in the city of Saratov and the Saratov region. The patients were divided into three groups depending on the stage of the disease: Group I — the patients with HIV infection in the incubation stage (Stage 1 — incubation), Group II — the patients with steadily progressing HIV infection (Stage 2 — stage of primary manifestations and Stage 3 — subclinical); Group III — the patients with continuing HIV replication, accompanied by the death of CD4+ lymphocytes and the depletion of their population to zero (Stage 4 — stage of secondary diseases and Stage 5 — terminal). The patients were followed up at the public health institution Saratov Regional Clinical Center for AIDS Prevention and Control. Results. The following patterns, confirmed statistically, were revealed: the lower the resistance of the patients to the action of stress agents was, the higher their anxiety was and significantly more often both the tendency to alexithymia and its obvious clinical signs were revealed. Thus, it is advisable for all patients, regardless of the stage of progression of HIV infection, to determine the levels of stress resistance, since with a decrease in this indicator, their level of anxiety increases, a tendency to alexithymia appears, and sleep disturbances, mood disorders, memory impairment, and decreased performance occur, in contrast to patients with high stress resistance.

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.

Accurate and reproducible enumeration of CD4 T cell counts and Hemoglobin levels using a point of care system: Comparison with conventional laboratory based testing systems in a clinical reference laboratory in Cameroon.

Measurements of CD4 T cells and hemoglobin (Hb) are conventionally used to determine the immunological state and disease progression for HIV-infected patients. We obtained a small lightweight point-of-care device, the BD FACSPrestoTM in order to demonstrate its ability to deliver CD4 and Hb analysis in comparison with two larger clinical machines the BDFACSCantoTM analyzer and Sysmex XN 1000 haematology analyzer. The advantages of using the POC device include access to HIV patient data in remote and in resource limited settings. The analytical performance of the BD FACSPrestoTM, compared with the FACSCantoTM II flow cytometer and the Sysmex XN 1000 haematology analyzer was evaluated by testing 241 routine clinical specimens collected in EDTA tubes from patients attending the Immunology and Microbiology laboratory of Chantal BIYA International Reference Centre (Yaounde, Cameroon) between January and May 2016. The mean in absolute counts and percentage of CD4 T cells was 606 cells/mL and 25% respectively via the FACSPrestoTM, and 574 cells/mL and 24% respectively via the BD FACSCantoTM II. The mean concentration of Hb levels was 11.90 on the Sysmex XN 1000 and 11.45 via the BD FACSPrestoTM, A high correlation (R2 = 0.95, P < 0.001) of Hb level measurements was noted between the BD FACSPrestoTM and Sysmex XN 1000 hematology analyzer. Overall, a Bland-Altman plot of the differences between the two methods showed an excellent agreement for absolute and percentage CD4 counts and hemoglobin measurements between POC and conventional methods evaluated here. Furthermore, the study demonstrated the ease of use of the BD FACSPrestoTM POC technology in remote areas. The BD FACPrestoTM is a suitable tool for CD4 enumeration in resource-limited settings, specifically providing a deployable, reliable POC testing option. The BD FACSPrestoTM performed appropriately in comparison to the conventional reference standard technologies. The BD FACSPrestoTM, system provides accurate, reliable, precise CD4/%CD4/Hb results on venous blood sampling. The data showed good agreement between the BD FACSPrestoTM, BD FACSCantoTM II and Sysmex XN 1000 XN 1000 systems.

Diabetes mellitus and associated risk factors among HIV infected patients on HAART

BackgroundUnderstanding the impact of disease associations is becoming a priority in Kenya and other countries bearing the load of infectious diseases. With the increased incidences of non-communicable diseases and the endemicity of infectious diseases in Sub-Saharan Africa, their co-existence poses significant challenges to patients, health workers and an overwhelmed health sector. Classical risk factors for diabetes such as physical inactivity and unhealthy diet may not solely explain the current trends, suggesting the role of novel risk factors including infections/inflammation. HIV and its treatment have been identified as potential contributors especially to patients with family history of confirmed diabetes cases. Co-infections frequently observed during HIV infection also significantly influence both the epidemiological and pathophysiological of the link between HIV and diabetes. Understanding the correlates of HIV and diabetes is crucial to inform management and prevention strategies of the twin infections. We therefore aimed to determine the prevalence of diabetes mellitus and risk factors in a population of HIV infected patients on HAART. This study determined the association of diabetes/impaired glucose regulation in the context of HIV-1. A cross-sectional study was conducted at a comprehensive care clinic in Nairobi (Kenya). Participants were screened for diabetes and impaired glucose regulation using random blood glucose and glycated haemoglobin (HbA1c) This paper describes the prevalence of diabetes mellitus in Human Immunodeficiency Virus positive individuals and the associated risk factors. We have demonstrated that family history is a risk factor for diabetes. While age and BMI are known risk factors, they were not associated with diabetes in this study.

IFNα induces CCR5 in CD4+ T cells of HIV patients causing pathogenic elevation

BackgroundAmong people living with HIV, elite controllers (ECs) maintain an undetectable viral load, even without receiving anti-HIV therapy. In non-EC patients, this therapy leads to marked improvement, including in immune parameters, but unlike ECs, non-EC patients still require ongoing treatment and experience co-morbidities. In-depth, comprehensive immune analyses comparing EC and treated non-EC patients may reveal subtle, consistent differences. This comparison could clarify whether elevated circulating interferon-alpha (IFNα) promotes widespread immune cell alterations and persists post-therapy, furthering understanding of why non-EC patients continue to need treatment.MethodsLevels of IFNα in HIV-infected EC and treated non-EC patients were compared, along with blood immune cell subset distribution and phenotype, and functional capacities in some cases. In addition, we assessed mechanisms potentially associated with IFNα overload.ResultsTreatment of non-EC patients results in restoration of IFNα control, followed by marked improvement in distribution numbers, phenotypic profiles of blood immune cells, and functional capacity. These changes still do not lead to EC status, however, and IFNα can induce these changes in normal immune cell counterparts in vitro. Hypothesizing that persistent alterations could arise from inalterable effects of IFNα at infection onset, we verified an IFNα-related mechanism. The protein induces the HIV coreceptor CCR5, boosting HIV infection and reducing the effects of anti-HIV therapies. EC patients may avoid elevated IFNα following on infection with a lower inoculum of HIV or because of some unidentified genetic factor.ConclusionsEarly control of IFNα is essential for better prognosis of HIV-infected patients.

The ecto-enzyme CD38 modulates CD4T cell immunometabolic responses and participates in HIV pathogenesis.

Despite abundant evidence correlating T cell CD38 expression and HIV infection pathogenesis, its role as a CD4T cell immunometabolic regulator remains unclear. We find that CD38's extracellular glycohydrolase activity restricts metabolic reprogramming after T cell receptor (TCR)-engaging stimulation in Jurkat T CD4 cells, together with functional responses, while reducing intracellular nicotinamide adenine dinucleotide and nicotinamide mononucleotide concentrations. Selective elimination of CD38's ectoenzyme function licenses them to decrease the oxygen consumption rate/extracellular acidification rate ratio upon TCR signaling and to increase cycling, proliferation, survival, and CD40L induction. Pharmacological inhibition of ecto-CD38 catalytic activity in TM cells from chronic HIV-infected patients rescued TCR-triggered responses, including differentiation and effector functions, while reverting abnormally increased basal glycolysis, cycling, and spontaneous proinflammatory cytokine production. Additionally, ecto-CD38 blockage normalized basal and TCR-induced mitochondrial morphofunctionality, while increasing respiratory capacity in cells from HIV+ patients and healthy individuals. Ectoenzyme CD38's immunometabolic restriction of TCR-involving stimulation is relevant to CD4T cell biology and to the deleterious effects of CD38 overexpression in HIV disease.