Long-standing Human Immunodeficiency Virus Infection Research Articles

ODP094 Hypercalcemia caused by Mycobacterium Avium Complex, with Excellent Response to Intravenous Pamidronate.

Abstract Background Hypercalcemia caused by granulomatous diseases such as sarcoidosis and tuberculosis, is a well-recognized entity. The pathophysiology of hypercalcemia associated with granulomatous diseases is related to increase conversion of 25 hydroxyvitamin D to its active form, 1,25 dihydroxyvitamin D, via extra-renal 1 -α hydroxylase activity. We present a patient with moderately sever hypercalcemia caused byMycobacterium Avium complex (MAC) infection in association with Human Immunodeficiency Virus (HIV) infection. Case Presentation The patient is 53-year-old male with longstanding HIV infection since 2003. He was referred to the endocrine clinic after an acute presentation to a local hospital in August 2021 with pancytopenia, lymphadenopathy, and hypercalcemia (corrected total calcium 13.8 mg/dl) with acute kidney injury. He was treated with intravenous fluids and subcutaneous Calcitonin injection. Endocrine work up showed low parathyroid hormone (PTH) at 3 pg/ml (14-95 pg/ml) and Parathyroid related peptide (PTHrP) level was <0.4 pmol/l. His 1,25 dihydroxy-vitamin D was elevated at 172 pg/ml (18-64 pg/ml) . Computed Tomography (CT) study for neck, chest and abdomen showed hepatosplenomegaly, generalized lymphadenopathy involving the left cervical area, left supraclavicular area, mediastinal, retroperitoneal, mesenteric and inguinal lymphadenopathy. Bone marrow study from August 2021 showed no evidence of leukemia, lymphoma, tuberculosis or other bone marrow inflammatory or infiltrative processes. Left sided neck lymph node biopsy showed diffuse granulomatous disease and numerous acid-fast organism consistent with Mycobacterium Avium complex (MAC) He was treated with azithromycin 250 mg daily, ethambutol 1200 mg daily, and rifabutin 300 mg daily in addition to anti-retroviral therapy (bictegravir/emtricitabine/tenofovir). Hypercalcemia was treated with one dose of pamidronate 90 mg which normalized serum calcium within one week. Glucocorticoids was not considered due to concerns over sever immunosuppression due to HIV/ AIDS and pancytopenia. Denosumab, ketoconazole and hydroxychloroquine were also not considered due to concerns over side effects. His 1,25 dihydroxy-vitamin D level normalized after four months from starting treatment with anti MAC therapy. Most recent calcium level 9.1 mg/dl, with 1,25 dihydroxy-vitamin D level of 31 pg/ml. Conclusion Mycobacterium Avium Complex infection is a possible cause of hypercalcemia, especially in immunocompromised individuals. Glucocorticoids, usually the first line treatment for acute hypercalcemia induced by 1,25 dihydroxyvitamin D overproduction, might not be appropriate in all patients. Alternatives include hydroxychloroquine, ketoconazole and parenteral bone anti- resorptive agents. Our patient had an excellent response to one dose of pamidronate. Ultimately his1,25 dihydroxy-vitamin D normalized with effective anti MAC therapy. Presentation: No date and time listed

Shorter Granulocyte Telomeres Among Children and Adolescents With Perinatally Acquired Human Immunodeficiency Virus Infection and Chronic Lung Disease in Zimbabwe.

BackgroundChronic lung disease (CLD) has been reported among African children with perinatally acquired human immunodeficiency virus (HIV) infection (C-PHIV), despite combination antiretroviral therapy (cART). In adults, shorter telomere length (TL) has been reported in association with both CLD and HIV. As little is known in children, our objective was to compare TL in HIV-positive (cART-naive or -treated) and HIV-negative children with and without CLD.MethodsParticipants included Zimbabwean C-PHIV, aged 6–16, who were either newly diagnosed and cART-naive, or on cART for >6 months, and HIV-negative controls of similar age and sex. Packed blood cell (granulocyte) TLs from 621 children were compared cross-sectionally between groups. For a subset of newly diagnosed C-PHIV, changes in TL following cART initiation were evaluated.ResultsC-PHIV had shorter granulocyte TL compared with uninfected peers, regardless of cART. Among 255 C-PHIV without CLD, TL was shorter in cART-naive participants. In multivariable analyses adjusted for age, sex, CLD, and HIV/cART status, shorter TL was independently associated with older age, being HIV positive, and having reduced forced vital capacity (FVC). Last, cART initiation increased TL.ConclusionsIn this cohort, C-PHIV and those with reduced FVC have shorter granulocyte TL, possibly the result of increased immune activation and cellular turnover due to longstanding HIV infection with delayed cART initiation.

Locating People Diagnosed With HIV for Public Health Action: Utility of HIV Case Surveillance and Other Data Sources.

Human immunodeficiency virus (HIV) case surveillance and other health care databases are increasingly being used for public health action, which has the potential to optimize the health outcomes of people living with HIV (PLWH). However, often PLWH cannot be located based on the contact information available in these data sources. We assessed the accuracy of contact information for PLWH in HIV case surveillance and additional data sources and whether time since diagnosis was associated with accurate contact information in HIV case surveillance and successful contact. The Case Surveillance-Based Sampling (CSBS) project was a pilot HIV surveillance system that selected a random population-based sample of people diagnosed with HIV from HIV case surveillance registries in 5 state and metropolitan areas. From November 2012 through June 2014, CSBS staff members attempted to locate and interview 1800 sampled people and used 22 data sources to search for contact information. Among 1063 contacted PLWH, HIV case surveillance data provided accurate telephone number, address, or HIV care facility information for 239 (22%), 412 (39%), and 827 (78%) sampled people, respectively. CSBS staff members used additional data sources, such as support services and commercial people-search databases, to locate and contact PLWH with insufficient contact information in HIV case surveillance. PLWH diagnosed <1 year ago were more likely to have accurate contact information in HIV case surveillance than were PLWH diagnosed ≥1 year ago ( P = .002), and the benefit from using additional data sources was greater for PLWH with more longstanding HIV infection ( P < .001). When HIV case surveillance cannot provide accurate contact information, health departments can prioritize searching additional data sources, especially for people with more longstanding HIV infection.

Coincidental Observation of Global Hypometabolism in the Brain on PET/CT of an AIDS Patient With High-Grade Pulmonary Non-Hodgkin Lymphoma

AIDS-related dementia complex is the most severe form of cognitive dysfunction in a patient infected with human immunodeficiency virus. The use of FDG PET/CT to diagnose AIDS-related dementia complex has been studied previously and shows various specific metabolic patterns from striatal hypermetabolism in early asymptomatic stage to global hypometabolism in advanced stages. We present a case of a 49-year-old patient with long-standing human immunodeficiency virus infection, where global brain hypometabolism was noted coincidentally on FDG PET/CT done for initial staging of primary pulmonary non-Hodgkin lymphoma.

Cholangiocarcinoma in a Young Woman With Perinatally Acquired HIV

Cholangiocarcinoma in a Young Woman With Perinatally Acquired HIV

Abnormal Cardiac Strain in Children and Young Adults with HIV Acquired in Early Life

Traditional measures of cardiac function are now often normal in adolescents and young adults treated with antiretroviral therapy for human immunodeficiency virus (HIV) infection. There is, however, evidence of myocardial abnormalities in adults with HIV. Cardiac strain analysis may detect impairment in cardiac function that may be missed by conventional measurements in this population. This was a retrospective study in which echocardiograms of HIV-infected subjects (n = 28) aged 7 to 29 years who participate in a natural history study of HIV acquired early in life were analyzed and compared with matched controls. Standard echocardiographic measures, along with speckle tracking-derived strain and strain rate, were assessed. Among the HIV-infected subjects, the median CD4 count was 667 cells/mm(3), and the mean duration of antiretroviral therapy was 14.6 years. Ejection fractions and fractional shortening were normal. There were no significant differences in measures of systolic or diastolic function between the groups. The HIV-infected group had borderline increased left ventricular mass indices. Global longitudinal and circumferential strain and strain rate, as well as global radial strain rate, were significantly impaired in the HIV-infected group compared with controls. There were no associations identified between left ventricular mass index or strain indices and current CD4 count, CD4 nadir, HIV viral load, or duration of antiretroviral therapy. HIV-infected participants demonstrated impaired strain and strain rate despite having normal systolic function and ejection fractions. Strain and strain rate may prove to be prognostic factors for long-term myocardial dysfunction. Therefore, asymptomatic children and young adults with long-standing HIV infection may benefit from these more sensitive measures.

Long-term membranous glomerulonephritis as the presenting manifestation of systemic lupus erythematosus in a patient with human immunodeficiency virus infection

The coexistence of human immunodeficiency virus (HIV) infection and systemic lupus erythematosus (SLE) is unusual, but the occurrence of SLE after HIV infection is even less common. Both conditions share similar clinical features including constitutional symptoms, facial rash, oral ulcers, alopecia, arthralgias, arthritis, seizures, cytopenias, glomerulonephritis, and antinuclear and antiphospholipid antibodies. This clinical overlap makes the diagnosis of SLE in a patient with pre-existing HIV infection difficult. Furthermore, immune complex glomerulonephritis with features resembling lupus nephritis has been described in HIV-positive patients. We present the case of a 45-year-old Hispanic woman with long-standing HIV infection who developed membranous glomerulonephritis with histological features of lupus nephritis. Five years after onset of renal disease she developed clinically evident SLE.

Undiagnosed HIV Infection among Adolescents Seeking Primary Health Care in Zimbabwe

Mother-to-child transmission of human immunodeficiency virus (HIV) infection was extremely common in southern Africa during the 1990s, and a substantial minority of infected infants have survived to reach adolescence undiagnosed. Studies have shown a high prevalence of HIV infection in hospitalized adolescents who have features associated with long-standing HIV infection, including stunting and frequent minor illnesses. We therefore investigated the epidemiology of HIV infection at the primary care level. Adolescents (aged 10-18 years) attending two primary care clinics underwent HIV and Herpes simplex virus-2 (HSV-2) serological testing, clinical examination, and anthropometry. All were offered routine HIV counseling and testing. Patients attending for acute primary care (APC) who were HIV infected were asked about their risk factors. Five hundred ninety-four participants were systematically recruited (97% participation), of whom 88 (15%) were attending for antenatal care. HIV infection prevalence was higher among APC attendees than among antenatal care attendees (17% vs 6%; P < .007), but for the prevalence of HSV-2 infection, a marker of sexually acquired HIV, the converse was true (4% vs 14%; P < .002). Seventy (81%) of 86 HIV-positive APC attendees were previously undiagnosed. They had a broad range of presenting complaints, with a median CD4 cell count of 329 cells/microL (interquartile range, 176-485 cells/microL) and a high prevalence of stunting, compared with the corresponding prevalence among HIV-negative attendees (40% vs 12%; P < .001). Maternal transmission was considered to be likely by 69 (80%) of the 86 HIV-positive APC attendees, only one of whom was HSV-2 positive. Unrecognized HIV infection was a common cause of primary care attendance. Routine HIV counseling and testing implemented at the primary care level may provide a simple and effective way of identifying older long-term survivors of mother-to-child transmission before the onset of severe immunosuppression and irreversible complications.

HIV Infection Presenting in Older Children and Adolescents: A Case Series from Harare, Zimbabwe

Symptomatic human immunodeficiency virus (HIV) infection during late childhood and adolescence may be an emerging problem in southern Africa, but it is one that is poorly described. We investigated social and clinical features in patients of this age group presenting to a HIV treatment clinic with special adolescent services in Harare, Zimbabwe. All patients aged 8-19 years and their guardians who attended an adolescent HIV treatment clinic were asked to consent to an interview and a review of medical notes. Of 32 patients, 17 (53%) were male. The median CD4 cell count at presentation was 101 cells/microL (interquartile range, 35-197 cells/microL). Sixty-two percent experienced stunting (mean Z score for height-for-age, -2.55; 95% CI, -2.00 to -3.10), and all presented with World Health Organization stage 3 or 4 HIV infection. The median age at the first HIV test was 11 years, with a median of 3.5 years delay since the first HIV-related illness. Recurrent respiratory tract infections, skin complaints, diarrhea, and past tuberculosis were the most common HIV-related complaints. Seventeen patients (55%) were double orphans, and 10 (62%) surviving parents were known to be HIV positive. In this small study, HIV-infected adolescents were profoundly immunosuppressed, with characteristics suggesting long-standing HIV infection. The equal sex distribution and high incidence of parental and sibling mortality were consistent; the majority of children had HIV-infected parents and, therefore, were potentially long-term survivors of HIV infection due to mother-to-child transmission. Greater recognition of the substantial burden of undiagnosed HIV infection and acquired immunodeficiency syndrome in this age group is needed, together with services aimed at reducing barriers to earlier diagnosis and initiation of treatment.

Fungal infections in children with human immunodeficiency virus infection

The increasing prevalence of fungal infections is caused in large part by the human immunodeficiency virus (HIV) epidemic. HIV-associated immunodeficiency is a major risk factor for invasive fungal disease. The prevalence of fungal infections in adults with HIV infection is markedly increased, and a large body of information about their incidence, course, and prognosis in adults exists. However, fungal infections, except candidiasis, are less common in children with HIV infection, and information about their pathogenesis is limited. The reason for this difference is unknown. This article reviews the occurrence of systemic fungal infections in children with HIV infection. Despite the relative rarity of infections with the ubiquitous and endemic fungi in the first 2 decades of the HIV epidemic, the increasing number of children with long-standing HIV infection in the era of highly active antiretroviral therapy warrants close surveillance for and aggressive treatment of fungal infections in children with HIV infection. Copyright © 2001 by W.B. Saunders Company

Lupus-specific autoantibodies in concomitant human immunodeficiency virus and systemic lupus erythematosus: Case report and literature review

Objectives: To report a case of systemic lupus erythematosus (SLE) in a patient with human immunodeficiency virus (HIV) infection. We also reviewed the medical literature for similar cases to assess the role of “lupus-specific antibodies” in the diagnosis of SLE in the presence of HIV infection. Methods: We described the presentation, clinical course, and serologic studies of our patient and reviewed the English language medical literature from 1966 to 1999 using MEDLINE with the keywords “SLE,” “HIV,” “acquired immune deficiency syndrome (AIDS),” and “autoantibodies.” Results: Our patient with long-standing HIV infection presented with fever, arthralgias and arthritis, photosensitive rash, oral ulcers, alopecia, headache, pleuritic chest pain, and lymphadenopathy. Laboratory testing showed leukopenia, thrombocytopenia, antibodies against ribonucleoprotein, Smith, and ribosomal-P, as well as immunoglobulin G anticardiolipin antibodies. Review of the literature revealed only 25 cases of concomitant SLE and HIV. In these cases, rheumatologic signs and symptoms were common in HIV and overlapped significantly with SLE. Autoantibodies also occurred frequently in both diseases. Conclusions: There are very few reported cases of concomitant HIV and SLE. These diseases may be largely mutually exclusive, but distinguishing the two can be difficult because of the high degree of rheumatic complaints and autoantibodies in HIV-positive patients. As illustrated by the patient presented, SLE should be considered in HIV-positive patients with rheumatologic complaints. Semin Arthritis Rheum 30:418-425. Copyright © 2001 by W.B. Saunders Company

Cat-scratch disease.

Cat-scratch disease (CSD) was first described by Debré in 1950, yet the causative bacterial agent of CSD remained obscure until 1992, when Bartonella (formerly Rochalimaea) henselae was implicated in CSD by serological and microbiologic studies. Bartonella henselae had initially been linked to bacillary angiomatosis (BA), a vascular proliferative disease most commonly associated with long-standing human immunodeficiency virus infection or other significant immunosuppression. Bartonella henselae has also been associated with bacillary peliosis, relapsing bacteraemia and endocarditis in humans. Cats are healthy carriers of B. henselae, and can be bacteraemic for months or years. Cat-to-cat transmission of the organism by the cat flea, with no direct contact transmission, has been demonstrated. Two new Bartonella species have been identified in the cat reservoir, namely: B. clarridgeiae and B. koehlerae. The role of these species in the aetiology of CSD still needs to be confirmed by isolation or DNA identification from lesions in humans. The author discusses the present state of knowledge on the aetiology, clinical features and epidemiological characteristics of CSD/BA, in addition to diagnosis, treatment and prevention.

Prognostic value of viremia in patients with long-standing human immunodeficiency virus infection. Swiss HIV Cohort Study Group.

Human immunodeficiency virus (HIV) viremia was evaluated in 73 patients with long-standing infection to investigate its relationship with clinical or biologic parameters and to assess its use as a predictor of clinical progression and death. After adjustment for other parameters, baseline HIV RNA level was significantly associated with baseline clinical stage and CD4 cell count. During follow-up (mean, 14.6 months), 16 patients died; 34 others had clinical progression of disease. In multivariate analysis, mortality was better predicted by baseline CD4 cell count (relative hazard [RH] for 100-cell decrease, 3.5; 95% confidence interval [CI], 1.5-8.2; P = .003) than by HIV RNA (P = .28) or clinical stage. HIV RNA level was the best predictor of clinical progression (RH for 1 log increase, 2.8; 95% CI, 1.6-4.9; P < .001). Monitoring of HIV RNA level may help to identify patients who might benefit from antiretroviral or prophylactic therapy.

Endoscopic Characterization of Idiopathic Esophageal Ulceration Associated with Human Immunodeficiency Virus Infection

Idiopathic esophageal ulcerations (IEUs) associated with human immunodeficiency virus (HIV) infection are now recognized as an important cause of esophageal disease in this population. Limited radiographic and endoscopic reports have almost uniformly described these lesions as solitary and giant. Over a 28-month period, we identified 68 IEUs endoscopically in 23 patients. Most patients had long-standing HIV infection and a low CD4(+) lymphocyte count. Multiple ulcers were identified in 57% of endoscopies. Giant ulcers were seen in one-third, with 37% < or = 1 cm in greatest dimension. Most of the lesions were in the mild- to distal esophagus. The ulcers were characterized as either shallow or intermediate in depth in 53%, with a deep ulcer in 7%. A "heaped-up" appearance of the ulcer was identified in 40%. An esophageal mucosal bridge(s) was seen in two patients. In contrast to previous reports, IEUs are variable endoscopically in number, size, and appearance. Given this lack of uniformity in appearance, which may mimic other causes of esophageal ulceration, all HIV-infected patients with an esophageal ulceration should undergo endoscopy with biopsy to obtain a definitive diagnosis.