Introduction Of HAART Research Articles

437. A Single-Center Experience of Solid versus Hematologic Malignancies in People Living with HIV

Abstract Background People living with HIV (PLWH) have an increased risk of cancer, including AIDS-defining and non-AIDS-defining malignancies. Some of the contributing factors are related to the high-risk lifestyle choices, but the introduction of HAART has reduced the incidence of AIDS-defining cancers. Methods We conducted a retrospective study of PLWH who were diagnosed with cancer between November 2019 and March 2022. We identified 60 patients who had HIV infection prior to the diagnosis (dg) of cancer or concurrently diagnosed with cancer. We evaluated patient’s characteristics, CD4 T cell counts, HIV viral load, adherence to HAART, solid and hematologic (HM) malignancies. Results Sixty pts were included in the analysis. The median age was 49.50 (range, 21-76 yrs) and 48 pts (80%) were male. The majority were African Americans (78.3%). Around 75% of pts were smokers, 35% of pts use alcohol, and 33.3% use illicit drugs. Cancer types were non-Hodgkin lymphoma (NHL) (11 pts, 18.3%), skin cancer (8 pts, 13.3%), Kaposi sarcoma (KS) (7 pts, 11.7%), prostate cancer (7 pts, 11.7%), head and neck cancer (5 pts, 8.3%), breast cancer (4 pts, 6.7%), Hodgkin lymphoma, leukemia, and lung cancer with same percentage each (3 pts, 5%), colorectal cancer (2 pts, 3.3%), and miscellaneous solid tumors (7 pts, 11.7%). AIDS-defining cancers were identified in 28.3% of pts. The median time between HIV and cancer dg was 8 years (range, 0-31 yrs). Eight pts (13.3%) were diagnosed with HIV and cancer at the same time [NHL (3 pts), myeloid leukemia (1 pt), and solid tumors different than cervical cancer (4 pts)]. A group of 43 pts (71.7%) had solid tumors were compared with 17 patients (28.3%) had HM. There were no differences between the two groups regarding gender, sexual orientation, smoking history, medical comorbidities, time between HIV and cancer dg. Pts with HM were younger (P-value of 0.05), and the rate of alcohol use was higher in pts with solid tumors (P-value, 0.003). HIV viral load > 200 copies/ml was higher in HM (75%) than solid tumors (44.1%) with P-value of 0.06 and the adherence rate to HAART was higher in pts with solid tumors (67.6%) compared to HM (38.4%) with a P-value of 0.1, prior to cancer dg. Conclusion PLWH with HM are more likely to be younger, non-adherent to HAART, and have higher HIV viremia compared to pts with solid tumors. Disclosures All Authors: No reported disclosures.

Gene Co-Expression Network Modular Analysis Reveals Altered Immune Mechanisms in HIV-HAND.

Although the introduction of HAART has completely changed the natural course of HIV infection, the number of chronic forms of HIV-associated neurocognitive disorder (HAND) has risen. It is estimated that up to half of subjects undergoing HAART therapy exhibit mild cognitive impairments. In the current study, we apply the gene co-expression network modular analysis, a well-established system biology approach, to the gene expression profiles of cases from the National NeuroAIDS Tissue Consortium (NNTC). We observed a negative enrichment for genes associated with the control of immune responses and putatively regulated by the transcription factors IRF8 and SPI1 and by both type I and II interferons. Our study provides evidence of altered immune responses, which are likely associated with the occurrence of HAND in the absence of HIV encephalitis (HIVE).

A STUDY OF OCULAR MANIFESTATIONS IN HIV/AIDS PATIENTS ATTENDING ART CENTRE AT TERTIARY CARE HOSPITAL OF SOUTH GUJARAT

Introduction:AIDS is a multisystem disease, which can affect any part of the eye& can lead to significant morbidity and mortality. Around 40-70% of patients with HIV infection develops one of the ocular manifestations during lifetime. Introduction of HAART had significantly reduced occurrence of opportunistic infections and neoplasia in these patients. Purpose:This study was conducted to study various ocular manifestations in HIV patients and to find out their prevalence and correlation with CD4 T Cell count. Material & Methods:We conducted a Cross-Sectional Study on 100 confirmed HIV patients taking HAART. We conducted detailed ocular examination of these patients including vision assessment, IOP measurement, slit lamp examination and fundus examination. CD4 T Cell count and Duration of the Disease was also noted. Results:We found 52% prevalence of HIV related ocular manifestations. Anterior Segment manifestations were more common than Posterior Segment. Dry Eye was the most common ocular finding accounting for 44.23% of the patients with ocular manifestations. Other Anterior Segment diseases included Cataract, Conjunctival Microvasculopathy, Blepharitis, Stye, Pterygium, Allergic Conjunctivitis, Anterior Uveitis and Viral Keratitis. Only 7 patients had Posterior Segment Diseases. 1 patient each of CMV Retinitis and PORN was seen, both having CD4 T Cell count below 100 cells/µl. Occurrence of these ocular manifestations were not related to age & gender of the patient or to the duration of the disease. Conclusions:All patients with HIV should undergo Ophthalmic examination, irrespective of the CD4 T Cell count, Duration of Disease or presence of symptoms. Screening help in detecting these ocular diseases at early stage and thereby with early initiation of appropriate treatment help in reducing the visual morbidity.

The Effect of miRNA Gene Regulation on HIV Disease.

Over many years, research on HIV/AIDS has advanced with the introduction of HAART. Despite these advancements, significant gaps remain with respect to aspects in HIV life cycle, with specific attention to virus-host interactions. Investigating virus-host interactions may lead to the implementation of novel therapeutic strategies against HIV/AIDS. Notably, host gene silencing can be facilitated by cellular small non-coding RNAs such as microRNAs paving the way for epigenetic anti-viral therapies. Numerous studies have elucidated the importance of microRNAs in HIV pathogenesis. Some microRNAs can either promote viral infection, while others can be detrimental to viral replication. This is accomplished by targeting the HIV-proviral genome or by regulating host genes required for viral replication and immune responses. In this review, we report on 1) the direct association of microRNAs with HIV infection; 2) the indirect association of known human genetic factors with HIV infection; 3) the regulation of human genes by microRNAs in other diseases that can be explored experimentally to determine their effect on HIV-1 infection; and 4) therapeutic interactions of microRNA against HIV infection.

Abstract PR-18: Risk prediction model for high-grade squamous intraepithelial lesions in persons living with HIV in Puerto Rico

Abstract Background: Persons living with HIV (PLWH) with concurrent HR-HPV infection are vulnerable to the development of anal high grade squamous intraepithelial lesions (HSIL), which greatly increase their risk of anal cancer. Despite anal cancer shares biological similarities with cervical cancer, there is no evidence-based screening recommendations. Clinical studies are underway evaluating clinical performance of anal cancer screening and optimal anal HSIL management approach. Due to the lack of evidence-based screening strategies for anal HSIL; we proposed to construct and validate a risk prediction model for anal HSIL among PLWH. Methods: We used data from the Anal Neoplasia Clinic (ANC) of the UPR Comprehensive Cancer Center from May, 2016 to April, 2021. From 688 HIV+ patients evaluated in the clinic during this period, 397 (57.7%) had information on biopsy-confirmed anal HSIL and thus were included in the analysis. The primary outcome was histologically confirmed anal HSIL. Potential predictors included demographic characteristics (e.g. sex at birth, age, and marital status), clinical characteristics (e.g. years living with HIV, last CD4 Nadir count, last HIV viral load, HPV vaccine, previous abnormal anal cytology, anal symptoms, HR-HPV result), and lifestyle risk factors (e.g. lifetime tobacco use, age at first sexual intercourse, lifetime number of sexual partners, history of anal sex, and history of STIs). For the prediction analysis, univariate logistic regression models (ULRM) were used to assess potential predictors of HSIL. Then, a multivariate logistic regression model (MLRM) was used to predict HSIL. The inclusion criteria for the MLRM were: (a) known or hypothesized risk factors for HSIL according to the scientific literature, (b) p-values < 0.25 in the ULRM, and (c) lower BIC and AIC values based on our data. After computing the probability of HSIL, we categorized these probabilities in deciles, to set the scale boundaries. Receiver-operating curves and the Area under the Curve (AUC) were constructed to summarize the performance of the scoring system. Results: Median age of patients was 45.8±12.6 and 72.0% were men. 47.6% had biopsy-confirmed anal HSIL and 52.4% had a benign lesion or LSIL; 37.5% had HR-HPV infection. Sex at birth, marital status, previous anal cytology, HIV diagnosis before HAART introduction, BMI, age at fist sexual intercourse, and HR-HPV were associated (p<0.25) with having HSIL according to the ULRM. Age, smoking, lifetime anal sex and history of STDs were also included in the MLRM. The AUC for the risk factor prediction model was 0.64 (95%CI: 0.51 – 0.77). Conclusion: Our risk prediction model showed a close to acceptable discrimination capacity for HSIL among PLWA. Further analysis with a bigger sample size and the consideration of additional biomarkers may be necessary to improve the prediction results. The development of risk-prediction models could lead to expansion of translational studies to inform future strategies to optimize current anal cancer screening strategies among PLWA. Citation Format: Marievelisse Soto-Salgado, Erick Suárez, Ashish Deshmukh, Tariz Viera, Jeslie Ramos-Cartagena, Luis R Pericchi, Ana Patricia Ortiz. Risk prediction model for high-grade squamous intraepithelial lesions in persons living with HIV in Puerto Rico [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PR-18.

Human immunodeficiency virus infection (HIV)-associated rheumatic manifestations in thepre- and post-HAART eras.

Rheumatic manifestations remain an important clinical manifestation associated to HIV. To date after 4 decades of the onset of the HIV/AIDS pandemic, almost 37 million individuals are living with the infection, including close to 2 million of newly infected individuals. The status, however, of a considerable proportion of HIV/AIDS patients has changed from a near fatal disorder secondary to opportunistic infections to a chronic disease in which renal cardiovascular, diabetes, malignancy, and autoimmune co-morbid disorders have become prevalent and relevant. In addition, the spectrum of rheumatic disorders also has changed since the introduction of HAART and its diagnosis and treatment represents a challenge. The purpose of this review is to define and discuss the HIV-related rheumatic manifestations in the pre- and post-HAART eras.

Incidence and time trends of anal cancer among people living with HIV in Australia.

Anal cancer incidence increased markedly in people living with HIV (PLWHIV) after the introduction of HAART, but in a few setting settings, recent declines have been reported. We report the incidence and time trends of anal cancer in PLWHIV in Australia. A data linkage study between the National HIV Registries and the Australian Cancer Database. Cases of anal squamous cell carcinoma (ASCC) in Australians aged 16 years and above diagnosed with HIV between 1982 and 2012 were identified. Standardized incidence ratios (SIRs) were calculated to compare incidence with that of the general population. Poisson regression models were developed to describe the time trends of ASCC over time and to compare ASCC risk within subgroups of PLWHIV. Among 28 696 individuals, a total of 129 cases of ASCC were identified. The crude incidence was 36.3 per 100 000 person-years and it increased sharply from 14.8 to 62.1 per 100 000 person-years between 1982-1995 and 2009-2012 (P trend <0.001). The SIR was 35.3 (95% confidence interval 29.5-42.0), and there was an inverse association between SIR and increasing age (P trend <0.001). In multivariate analyses, ASCC incidence was significantly higher in recent years (P trend <0.001), in those who acquired HIV through male homosexual contact (P = 0.002), and in those who had a history of AIDS (P < 0.001). PLWHIV in Australia are at markedly higher risk of anal cancer. Unlike in some industrialized countries with a mature HIV epidemic, the incidence of anal cancer is still increasing in this population in Australia.

Breast cancer in women living with HIV.

With the introduction of HAART, the life expectancy of the patients infected with HIV almost approached that of the general population. The incidence of certain HIV-Associated cancers as Kaposi Sarcoma (KS) and Non-Hodgkin Lymphoma (NHL) decreased, while an increase in Non-AIDS-Defining cancers (NADCs) has been documented. HIV infection is a risk factor for numerous cancers in PLWH. Breast cancer is the most common cancer worldwide among all women. The association between HIV infection and breast cancer has not been thoroughly investigated: when compared to the general population, people living with HIV/AIDS (PLWHA) have a similar or slightly lower risk of breast cancer. Screening tests are essential weapons to fight cancer burden and more effective therapeutic and preventive strategies are needed, especially among PLWHA. Further and more comprehensive studies are needed to better characterize breast cancer among PLWH.

EFFECTS OF ECLIPSE PHASE AND DELAY ON THE DYNAMICS OF HIV INFECTION

In this paper, an HIV infection model with eclipse phase, humoral immune response and immunological delay has been discussed. By studying the characteristic equations of the model, the local stability analysis of various equilibrium points has been explored. Treating the delay as the bifurcation parameter, it has been shown that the delay can destabilize the stability of the infected steady-state leading to Hopf bifurcation and periodic solutions. By using Lyapunov functionals and LaSalle’s invariance principle, the global stability analysis of the boundary equilibrium points has also been explored. It has also been shown numerically that the inclusion of the drug therapy in the model generates sporadic outbursts of virus called viral blips. In the end, numerical simulations have been employed to justify the analytical results proved in the paper. Biologically, the proposed model can explain the presence of viral blips in the system, during the introduction of HAART, as observed in the HIV-infected patient. These blips could mark the viral advancement in the system, thus resulting in complete immunological failure. One of the reasons for these viral blips can be the presence of delay in the activation of immunological response. But the development of drug-resistive virus could also be the reason for this sudden rise in viral loads. Moreover, the incorporation of the delay in the model generates oscillations and periodicity in the model, thus validating the long latency period seen in most HIV-infected patients. Also, a longer delay in the activation of immune response marks a viral advancement in the viral timeline resulting in viral blips, which signify the evolution of the virus.

Cryptococcal Meningitis: A Retrospective Cohort of a Brazilian Reference Hospital in the Post-HAART Era of Universal Access.

Objective Cryptococcus neoformans is a common opportunistic infection in adults with acquired immunodeficiency syndrome worldwide. However, limited data exist for HIV-infected patients in the post-HAART (highly active antiretroviral therapy) era in Brazil. The aim of this study was to describe the clinical characteristics and outcomes of cryptococcosis in a cohort of patients attending a teaching tertiary care hospital in southern Brazil after the introduction of HAART in Brazil. Patients and Methods A retrospective study was conducted in tertiary care hospital in southern Brazil. Detailed data on risk factors, clinical manifestations, diagnosis methods, treatment, and prognosis of patients with meningeal cryptococcosis were evaluated from January 2009 to December 2016. Results Seventy-nine cases of cryptococcal meningitis were identified. Most of the patients presented positive CSF (cerebrospinal fluid) cultures for Cryptococcus neoformans (96%). The prevalence of males and females with meningeal cryptococcosis was similar. The age of the patients ranged from 5 to 67 years. The median time of hospitalization was 28 days. The most common underlying disease was HIV (82%), followed by solid transplant (10%). Fever, nausea, vomiting, headache, and altered mental status were the most common clinical manifestations. Initial opening intracranial pressures varied from 30 to 130 cm H2O. CNS imaging abnormalities include hydrocephalus and hypodensities. Widened Virchow–Robin spaces were described in only 2 patients (2.5%). Induction treatment of the majority of the patients consisted of amphotericin B and flucytosine (67%) followed by amphotericin B and fluconazole (19%). Multivariate analysis of Cox regression identified headache at presentation, mechanical ventilation, CSF glucose <20 mg/dL, and CSF cryptococcal antigen ≥1 : 1000 for independent risk factors for death. All-cause 30-day and 60-day mortalities were 19% and 24%, respectively. Conclusions Meningeal cryptococcosis mostly caused by C. neoformans continues to occur predominantly in HIV-infected adults despite HAART being widely distributed in Brazil. Cryptococcosis remains a significant opportunistic infection in solid organ transplant recipients. Despite adequate antifungal treatment and management of intracranial hypertension in a reference tertiary care hospital, mortality was high. Identification of risk factors and additional treatment modalities, especially for intracranial hypertension, are necessary to improve care for patients with cryptococcal meningitis.

Dermatological manifestations of acquired immunodeficiency syndrome: an observational study among HAART naive patients from an ART centre of excellence

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-GB"&gt;Dermatological manifestations can be a window to the clinical and immunological status of patients with HIV infection. Introduction of HAART has dramatically shifted the pattern of HIV associated dermatoses. The present study has been carried out to find out the same among HIV infected patients not started on HAART therapy&lt;/span&gt;&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Two hundred (200) HIV-positive, HAART-naïve patients attending ART centre of excellence were examined between November 2005 to July 2007, for the presence of mucocutaneous manifestations, correlation with CD4 count and analyzed using SPSS software&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Out of the 200 patients examined, 64.5% (n=129) were found to have mucocutaneous manifestations. Out of those 129 patients 70 (54.3%) were male and 59 (45.7%) were females. Age of the patients ranged from 5 to 62 years with a mean±S.D of 32.08±11.48 yrs. Fungal infections (n=67, 51.9%) were the most common infectious dermatoses, followed by viral infections (n=35, 27.1%), scabies infestations (n=17, 13.2%) and bacterial infections (n=2, 1.6%). Of all the fungal infections, candidiasis (43.28%) was the commonest. Majority (64.5%) of the mucocutaneous manifestations were seen in patients with CD4 count &amp;lt;200 cells/mm&lt;sup&gt;3&lt;/sup&gt; and difference in CD4 count was significantly associated with cutaneous penicilliosis and oral hairy leukoplakia (p&amp;lt;0.044). &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Infectious dermatoses remain as the far most common skin manifestations in HAART naïve patients. Lower the CD4 higher will be the incidence. Rare endemic infections like penicilliosis should be considered in differentials of umbulicated lesions in this part of the country.&lt;/span&gt;&lt;/p&gt;

From Needs and Dilemmas Facing View of Elderly People Living with HIV/AIDS Long-Term Care Measures in Taiwan

The life of people living with HIV has been prolonged with HAART, and since 1997 the introduction of antiretroviral HAART in Taiwan has increased the survival rate of infected people to 85.9%. Therefore, with the extension of the life of people living with HIV and the entry into the old age, how to provide suitable long-term care services is an issue that Taiwan policy needs to face and think. This research through surveys and interviews to find Taiwan elderly people living with HIV in Taiwan needs and plight of the contains (1) diseases and health care issues, (2) social prejudice and discrimination (3) psychology and adjustment of the identity and reflection (4) adjustment of interpersonal relationships. According to the empirical data shows Taiwan's long-term care measures in difficulties arising in the care for older people living with HIV (1) non-suitable for elderly people living with HI community long-term care services; (2) long-term care institution the exclusion of people living with HIV (3) lack of financial resources of older living with HIV with using institutional long term care. (4) the incoherence of HIV medical and long-term care measures. (5) course focuses on long-term care health care, neglect the psychosocial dimensions of older people living with HIV. This study attempts to present long-term care of the elderly people living with HIV needs and challenges and dilemmas facing in Taiwan.

Causes of death and mortality trends of all individuals reported with HIV/AIDS in Israel, 1985-2010.

BackgroundHighly active antiretroviral therapy (HAART) has changed life-expectancy and mortality trends among people living with HIV/AIDS (PLWHA) since 1996. This retrospective cohort study aimed to assess the mortality epidemiology of PLWHA in Israel and analyze the causes of death.MethodsThis cohort study included all adult Israeli-citizens PLWHA between 1985 and 2010 and crossed matched with the Civil Registry to identify those who died. Death certificates were classified into AIDS or non-AIDS deaths related-causes. Standardized mortality-ratio (SMR) represented mortality excess.ResultsOf all 5140 PLWHA who were followed-up for 36 955 person-years, 1066 (20.7%) died. The ratio of AIDS-related deaths to non-AIDS related deaths reduced from 1.2:1 before 1996 to 0.6:1 after 1997, and case-fatality rates reduced from 12.0 to 0.9%, respectively (P < 0.001). SMR were 3.0 (95% CI: 2.3–3.5) for males and 3.9 (95% CI: 3.3–4.5) for females.Fatality cases were more likely older Israeli-born males, co-infected with tuberculosis, reported before 1996 and acquired HIV by drug-injection or infected-blood products. Deaths of AIDS-related causes were common among Israeli-born gay men, while non-AIDS deaths were common among those reported after 1997 and drug users.ConclusionsDeath rates declined since HAART introduction. Yet, SMR remained high, and PLWHA infected by drug-use or blood-products have not enjoyed relative longevity.

Predictors of Hospitalization among Children on ART in Ethiopia: a Cohort study.

Substantial progress has been made in the management of pediatric HIV infection in Ethiopia with the implementation of mother-to-child-prevention programs. Since the introduction of HAART in 2005, mortality among HIV-infected children has reduced while the rate of hospitalization was expected to rise. The purpose of this study, therefore, was to assess predictors of hospitalization in children on ART in seven university referral hospitals in Ethiopia. A prospective cohort study design was employed on children age 0-18 years as part of a multisite observational study. ART-experienced eligible and ART-naïve children with HIV/AIDS were enrolled into the Advanced Clinical Monitoring (ACM) till December 31, 2012 were included. From the database, information on hospitalization and other independent variables were extracted. Analysis was done using both SPSS for Windows version 16.0 and STATA. Descriptive analyses and modeling was done using logistic regression. Of the 405 children on ART (174 experienced, 231 naive), 86 (20.7%) were hospitalized for various reasons; two children were excluded since they were hospitalized for unrelated conditions (appendicitis and burn). Fifty one (60.7%) of the eighty four admitted children were hospitalized in the first six months of ART initiation. Of the independent variables, only the presence of opportunistic infections and duration on ART were significantly associated with hospitalization both on bi-variable and multivariable analyses (P-value <0.05). As the duration on ART increased by one month, the risk of hospitalization decreased by 5.4%, which is statistically significant (P < 0.001). Whereas the incidence (number) of OI's increased by one, the risk of being hospitalized increased by 35.2% (P = 0.002). Of the individual opportunistic infections, pneumonia was found to be the only predictor of hospitalization (P-value = 0.002). This study showed that nearly two-third of the hospitalization was within 6 months of initiation of ART; and presence of OI and duration on ART were the only predictors of hospitalization.

Lymphoproliferative response after stimulation with soluble leishmania antigen (SLA) as a predictor of visceral leishmaniasis (VL) relapse in HIV+ patients

The introduction of HAART resulted in the decrease of Leishmania/HIV co-infection cases; nevertheless, the number of relapses remains high and secondary prophylaxis is recommended. However, secondary prophylaxis is not necessary in all patients, and presents a high risk of toxicity and an elevated cost. Our aim was to study whether specific cellular response to Leishmania infantum (measured by cell proliferation response after stimulation with soluble Leishmania antigen (SLA)), could be a useful tool to attempt a secondary prophylaxis withdrawal. In June 2009 an outbreak of leishmaniasis by Leishmania infantum was declared in the southeast of Madrid, and since January 2013, we recruited 10 HIV+ patients that had been treated for visceral leishmaniasis. 6 patients had positive SLA-cell proliferation test. The mean CD4 cell counts of those patients with positive SLA were 140 cel/mm3 and 40 cel/mm3 in those with negative SLA test. 3 patients with positive SLA-cell proliferation test (CD4 count: 336, 307, 625) were not on prophylaxis, and the other 3 patients (CD4 count: 152, 189, 359) were on secondary prophylaxis that was withdrawn after the positive SLA-cell proliferation test with no posterior relapses (mean follow up 60 weeks). From the 4 patients, which had negative SLA-cell proliferation test and continued on prophylaxis, 3 had positive PCR for Leishmania at the end of the follow-up and 2 presented clinical relapses.The performance of SLA-cell proliferation test can be a useful tool that can permit us to try withdrawal of the prophylaxis in Leishmania/HIV co-infected patients with low CD4+ counts under clinical supervision, diminishing risk of toxicity and cost.

Clinical presentation and treatment outcome of HIV associated Kaposi sarcoma in a tertiary health centre in Nigeria

Objective: Kaposi sarcoma (KS) is the most common tumour among AIDS patients and is considered as an AIDS defining illness. However, the introduction of HAART has led to a decline in the incidence of the disease among these patients. The objective of this study is to review the clinical presentation, treatment and outcome of HIV associated KS in a tertiary health facility in Nigeria. Methods: Records of all patients that were managed with HIV associated KS from January 2012 to December 2014 at Aminu Kano Teaching Hospital were reviewed and data obtained was analysed using a computer statistical software. Results: During the period under review, 3705 patients were recruited in the antiretroviral treatment (ART) clinic out of which 24 were found to have HIV associated KS giving a period prevalence of 0.65%. The male to female ratio was 2.4:1. The mean age of the patients was 39.46 (±8.75) years. Six cases (25%) were diagnosed to have HIV as a result of KS. The remaining 75% were all on 1st line ARVs. Nine patients (37.5%) had treatment for Tuberculosis before they were diagnosed with KS. Based on the ACTG classification, 58.3% were poor risk group. Treatments given to the patients include HAART for 2 patients and 4 patients (16.7%) absconded. The remaining 18 patients had chemotherapy in the form of combination of intravenous Adriamycin, Bleomycin and Vincristine (ABV) with variable outcomes. Five patients failed ABV and had Paclitaxel given. At the end of the chemotherapy, 14 patients (58.3%) were in remission with 5 (20.8%) mortalities. There is no statistically significant difference between CD4 count before and after chemotherapy (P&gt;0.05) Conclusions: Majority of our patients are classified poor risk. Paclitaxel can be used as second line treatment. Treatment of KS does not improve CD4 count in patients with HIV. There is need to clinically identify patients with KS early in ART centre in order to improve outcome.

Ocular Manifestations in Patients with Human Immunodeficiency Virus Infection in the Pre-HAART Versus the HAART Era in the North Indian Population

ABSTRACTPurpose: To compare changes in the demographic profile and ocular manifestations in patients with HIV in the pre-HAART and HAART era in North India.Methods: In this single-center cross-sectional study, 100 HIV patients receiving HAART and 96 HIV patients in the pre-HAART era were enrolled. Prevalence of ocular manifestations of HIV was calculated for both cohorts.Results: The prevalence of ocular manifestations was not statistically different in the two eras (38%, SE: 4.85% in HAART era; 41.67%, SE: 5% in pre-HAART era) (p = 0.60). Mean CD4 counts were lower in the pre-HAART era compared with the HAART era (p < 0.001). In the HAART era, cytomegalovirus (CMV) retinitis and HIV retinopathy continued to remain the most common infectious and non-infectious cause of visual morbidity.Conclusions: While the introduction of HAART has resulted in a major impact on the overall health of patients with HIV, the spectrum of ocular disease remains largely unchanged in developing countries such as India.

The child and adolescent with HIV in resource poor countries.

Although sub-Saharan Africa caries the burden of paediatric and adult HIV/AIDS infections, the epidemic is spreading most rapidly in the Middle East and North Africa Region where between 2005 and 2013, AIDS-related deaths increased by 66% in comparison with a worldwide fall of 35%. For the first time, in 2011, more than half of people in need of antiretroviral drugs were receiving them, with coverage reaching 54%; yet only28% of children have access to HIV treatment. This review sought to provide an update of paediatric and adolescent oral HIV/AIDS issues in resource poor countries. To review the literature on paediatric & adolescent HIV with a focus on oral lesions as predictors of HIV infection; as markers of the efficacy of HAART and quality of life; caries risk; management of oral lesions; and epidemiological tests for clinical significance of oral lesions. A search strategy was developed for PubMed to identify papers on paediatric oral HIV. Publications in English were selected on the basis that their titles and abstracts were relevant to the review objectives. The reference lists of included papers were screened for additional articles. The time-search for publications was limited from 2009 to 15 October 2014. Papers on the prevalence of oral lesions lacked standardization in diagnostic criteria and the introduction of HAART had significantly reduced prevalence; oral lesions remain useful predictors for HIV infection and as markers for the efficacy of HAART. Evidence suggest that caries risk is increased with HIV infection; management of oral lesions is inconsistent with available resources and surprisingly little recent information has been published in the past 5 years. Revised case definitions are proposed for large-scale epidemiologic studies with the development of an oral lesion index showing promise. Oral health quality of life indicators for children and adolescents are becoming important as more of these indicators are being developed and their negative oral impacts in individuals with oral lesions are now well established. Paediatric and adolescent oral HIV research needs to be prioritized as current studies are few and are characterized by poor quality study designs, small study samples and a lack of multicentre collaborations. There is a lack of high quality evidence for a number of interventions available for management of oral lesions.

The Impact of HAART in the Gastrointestinal Tract

Discovery of HAART announced the transformation of HIV infection from a deadly illness to a chronic manageable disease. The objective of this study is to show the impact of HAART in the GI tract. This study was conducted through online research using the database of NCBI. Multiple studies have shown that HAART has changed the clinical presentation of gastrointestinal disorders; oral lesions have decreased more than 30%; opportunistic disorders decreased from 69% to 13%. HIV patients with diarrhea receiving PI had a higher rate of response; 62% versus 33.5%. This population is at increased risk for developing malignancies of the GI tract; both proximal and distal. Even though with the introduction of HAART, patients with HIV have improved life expectancy rates and survival, public health strategies to improve cancer screening are needed.

Gender effects on zolpidem efficacy and safety

Gender effects on zolpidem efficacy and safety