Main Opportunistic Infections Research Articles

Epidemiological, Clinical and Biological Aspects of Childhood HIV in Libreville

Introduction: Human immunodeficiency virus (HIV) infection is a chronic viral infection characterized by the progressive destruction of CD4 T lymphocytes. Its prevalence in Gabon is estimated 4.1% with approximately 2,500 affected children. This pathology remains a real public health problem on a global scale. The objective of our work was to describe the epidemiological, clinical and biological aspects of HIV-positive children in Libreville. Materials and Methods: This is a retrospective study which involved patients followed in the four major pediatric care centers in Libreville from January 2015 to December 2022. We included all complete medical records of children and adolescents aged 0 to 19 years with positive HIV serology or PCR. Results: The mean age was 10.6 ± 5.1 years. The 10-14 year old group represented 32.3%. The sex ratio was 1.13 male to female. In our study 46.9% were orphans and they were more affected by academic delay (51.9% versus 45.7%). The clinical signs were dominated by fever (40.6%). The main opportunistic infection found was digestive (7.3%) and tuberculosis represented the first co-infection (13.2%). We had 5.2% of patients with acute malnutrition. Conclusion: HIV-AIDS in children remains a public health problem given its socio-economic impact on the population. The cost of follow-up assessments and hospitalizations are among the problems that slow down the regular follow-up of our patients.

Novelties for the management of cytomegalovirus after kidney transplantation

Cytomegalovirus (CMV) infection is the main opportunistic infection observed after kidney transplantation. Despite the use of prevention strategies, CMV disease still occurs, especially in high-risk patients (donor seropositive/recipient seronegative). Patients may develop complicated CMV, i.e. recurrent, refractory or resistant CMV infection. CMV prevention relies on either universal prophylaxis or preemptive therapy. In high-risk patients, universal prophylaxis is usually preferred. Currently, valganciclovir is used in this setting. However, valganciclovir can be responsible for severe leucopenia and neutropenia. A novel anti-viral drug, letermovir, has been recently compared to valganciclovir. It was as efficient as valganciclovir to prevent CMV disease and induced less hematological side-effects. It is still not available in France in this indication. Recent studies suggest that immune monitoring by ELISPOT or Quantiferon can be useful to determine the duration of prophylaxis. Other studies suggest that prophylaxis may be skipped in CMV-seropositive kidney-transplant patients given mTOR inhibitors. Refractory CMV is defined by the lack of decrease of CMV DNAemia of at least 1 log10 at 2 weeks after effective treatment. In case of refractory CMV infection, drug resistant mutations should be looked for. Currently, maribavir is the gold standard therapy for refractory/resistant CMV. At 8 weeks therapy and 8 weeks later, it has been shown to be significantly more effective than other anti-viral drugs, i.e. high dose of ganciclovir, foscarnet or cidofovir. However, a high rate of relapse was observed after ceasing therapy. Hence, other therapeutic strategies should be evaluated in order to improve the sustained virological rate.

Opportunistic Infections and Impact on Morbidity and Mortality During HIV in the Infectious Diseases Department at Point G Hospital in Bamako

Aim: In the contexts of free treatment and the "test and treat" strategy, we conducted this study whose objectives are to identify the main opportunistic infections (OIs) and their impact on the future of HIV-infected patients. Patients and methods: This was a cross-sectional retrospective study of variables from the medical records of HIV-infected person hospitalized between January 1, 2015 and December 31, 2021. Results: Out of 2631 hospitalized patients, 1237 were HIV-positive (47%), 54,4% had OIs. The sex ratio was 0.86 and the mean age was 38.9 ± 10.37 years. The main opportunistic infections are candidiasis (39.32%), tuberculosis (25.25%) and cerebral toxoplasmosis (14.57%). The lethality was 43.7% (540/1237). Death was statistically related to opportunistic infections: tuberculosis (p <0.0001), toxoplasmosis (p = 0.004), candidiasis (p <0.0001) and prurigo (p = 0.04) and stage 4 of WHO (p <0.0001) and CD4 ≤ 200 / ml. Conclusion: Death was statistically related to tuberculosis, toxoplasmosis, and stage 4 of WHO deep immunosuppression and CD4 ≤ 200/ml as reported by candidiasis and prurigo. Screening and early management of opportunistic infections and even HIV will help lower mortality

HIV Infection in Patients Aged Over 50 in the Infectious Diseases Unit at Brazzaville University Hospital: Prevalence and Associated Factors

Objective: The prevalence of HIV infection in people aged is of significant importance. We determined the prevalence of HIV infection with patients aged over 50 at the Brazzaville University Hospital and look for its associated factors. Patients and Method: Cases of HIV infection in patients over 50 years admitted to the Infectious Diseases Unit of Brazzaville University Hospital were examined under cross-sectional descriptive and analytical study. This survey concerns the period going from January 1, 2019 to June 30, 2021. Results: There were one hundred and ninety-four patients (8.2% of admissions). Their mean age was 57.40 ± 6.4 years [50-93], they were mostly female (n = 113; 58.2%). The most dominant population was the age group between 50-59 years (n = 136; 70.1%). They were single people (n = 80; 41.2%), without profession (n = 87; 44.8%), with a primary education level (n = 81; 41.8%), hypertensive (n = 27; 13.9%), diabetics (n = 15; 7.7%). HIV infection was discovered during hospitalization (n = 111; 57.2%), for deterioration of the general condition (n = 72; 37.1%), long-term fever (n = 56; 28.9%), chronic cough (n = 40; 20.6%). The patients were at WHO stage 3 (n = 133; 68.6%). The mean CD4 were 188.5 ± 11.7 / mm3 [19-433]. In 172 cases (88.7%), the patients had two sexual partners and did not use a condom (n = 189; 97.4%). The main opportunistic infections were tuberculosis (n = 74; 18.1%) and cerebral toxoplasmosis (n = 48; 24.7%). ART was made with the combination of TDF + FTC + EFV (n = 79; 40.7%). The observation was poor in 33% (n = 64) and unfavourable outcome in 47.4% (n = 92). These were IRIS (n = 5; 2.6%) and death (n = 85; 43.8%), due to anaemic shock (n = 17; 20%), septic shock (n = 8; 9.4%). Marital status (P = 0.04), WHO stage (p = 0.02), and non-compliance treatment (p = 0.0001) could have the link with the death patients. Conclusion: HIV infection in people over 50 years is relatively common at Brazzaville University Hospital, especially among single women. The lethality remains high, unrelated to an opportunistic infection but rather with the notion of non-compliance with treatment and the advanced stage of HIV infection according to the WHO classification. This shows the interest in raising awareness among this population for early detection and the treatment of HIV.

Clinical and biological profile of newly diagnosed HIV-infected patients in Casablanca

Abstract Background HIV infection continues to be a major global public health issue. UNAIDS estimates that 690 000 HIV-related deaths occurred in 2019. In Morocco The number of people living with HIV was estimated at 21,000 in 2018. HIV prevalence in Morocco remains low (around 0.1%) in the general population. It is much higher among female sex workers, men who have sex with men (MSM), people who inject drugs and migrants. In Casablanca the epidemic is concentrated among MSM. The aim of this study was to describe the epidemiologic, clinical and immuno-virological characteristics of people newly diagnosed with HIV infection managed in the Ibn Rochd teaching Hospital of Casablanca. Methods A cross-sectional study was performed including patients newly diagnosed with HIV infection and managed in the infectious diseases department from January 1st, 2017 to June 30, 2018. Data were collected from patient's medical records and were analyzed using SPSS 16. Main outcomes were presented as mean and pourcentages. Results 525 patients newly diagnosed with HIV infection were managed during the 18 months period in the Infectious Diseases Department. The mean age was 36.1 years, with a sex ratio of 1.1. Among them, 43% were single and 61.7% were unemployed. Heterosexual transmission mode represented 65.5% and MSM represented 23%. The seropositivity was discovered through an evocative symptom in 47.8% of all cases. The main clinical symptoms were: weight loss (16.6%) and oral candidiasis (11.2%). The main opportunistic infection was tuberculosis (23%). 36.1% of cases were diagnosed at acquired immunodeficiency syndrome (AIDS) stage. Medians of the first CD4 count and viral load performed were respectively 248/mm3 and 88 174 copies/ml. Conclusions Despite a good antiretroviral coverage, HIV infection is still diagnosed late in our country. The emphasis must be on the promotion of voluntary testing mainly among groups at high risk of infection. Key messages More active offer of HIV testing, by general practitioners, should play a crucial role in the early identification of HIV infections. Strategies such as use of preexposure prophylaxis should be developed to prevent HIV transmission among MSM.

COVID-19-associated opportunistic infections: a snapshot on the current reports.

Treatment of the novel Coronavirus Disease 2019 (COVID-19) remains a complicated challenge, especially among patients with severe disease. In recent studies, immunosuppressive therapy has shown promising results for control of the cytokine storm syndrome (CSS) in severe cases of COVID-19. However, it is well documented that immunosuppressive agents (e.g., corticosteroids and cytokine blockers) increase the risk of opportunistic infections. On the other hand, several opportunistic infections were reported in COVID-19 patients, including Aspergillus spp., Candida spp., Cryptococcus neoformans, Pneumocystis jiroveci (carinii), mucormycosis, Cytomegalovirus (CMV), Herpes simplex virus (HSV), Strongyloides stercoralis, Mycobacterium tuberculosis, and Toxoplasma gondii. This review is a snapshot about the main opportunistic infections that reported among COVID-19 patients. As such, we summarized information about the main immunosuppressive agents that were used in recent clinical trials for COVID-19 patients and the risk of opportunistic infections following these treatments. We also discussed about the main challenges regarding diagnosis and treatment of COVID-19-associated opportunistic infections (CAOIs).Supplementary InformationThe online version contains supplementary material available at 10.1007/s10238-021-00751-7.

Clinical and prognostic features of cerebral toxoplasmosis in HIV-infected patients in Lubumbashi, Democratic Republic of the Congo

Introduction: Cerebral toxoplasmosis is the main opportunistic infection of the central nervous system (CNS) during in human immunodeficiency virus (HIV)-infection. The purpose of this study is to describe current epidemiologic, clinical, diagnostic, and prognostic features of cerebral toxoplasmosis during HIV-infection in hospital setting in Lubumbashi. Methods: This descriptive and analytic study examined the records of 21 HIV-positive patients with cerebral toxoplasmosis. Data were collected over 36 months (from January 2015 to December 2017) at the HIV/AIDS Center of Excellence in Lubumbashi (Democratic Republic of the Congo). Results: Twenty-one patients on 4,283 followed for HIV-infection completed the diagnostic criteria (a prevalence of 0.5%) with a sex ratio (M / F) of 1.3 and a mean age of 41.0±6 years. Major clinical manifestations were fever (100%), headaches (100%), motor deficit (61.9%), intracranial hypertension (47.6%), seizures (47.6%), and disorders of consciousness (42.9%). Cerebral imaging studies (4 Computed tomography scan) were performed and showed hypodensities with peripheral enhancement by cockade in 75% of the cases. The mean CD4 T-cell counts was 180.6±161.9 cells / mm3. Co-trimoxazole was the main anti-toxoplasma drug in all cases. The lethality rate was 42.9%. Conclusion: Early detection and primary prevention in HIV-infected patients remain essential to improve the prognosis and survival of these patients.

HIV-Associated Disseminated Histoplasmosis and Rare Adrenal Involvement: Evidence of Absence or Absence of Evidence.

Adrenal histoplasmosis and primary adrenal insufficiency are mostly described in immunocompetent patients. This particular tropism is attributed to the presence of cortisol within the adrenal gland, a privileged niche for Histoplasma growth. In French Guiana, disseminated histoplasmosis is the main opportunistic infection in HIV patients. Our objective was to search in our HIV-histoplasmosis cohorts to determine how frequent adrenal insufficiency was among these patients. Between January 1, 1981 and October 1, 2014, a multicentric retrospective, observational study of histoplasmosis was conducted. Patients co-infected by HIV and histoplasmosis were enrolled in French Guiana’s histoplasmosis and HIV database. Among 349 cases of disseminated histoplasmosis between 1981 and 2014, only 3 had adrenal insufficiency (0.85%). Their respective CD4 counts were 10, 14 and 43 per mm3. All patients had regular electrolyte measurements and 234/349 (67%) had abdominal ultrasonography and 98/349 (28%) had abdominopelvic CT scans. None of these explorations reported adrenal enlargement. Overall, these numbers are far from the 10% reports among living patients and 80-90% among histoplasmosis autopsy series. This suggests 2 conflicting hypotheses: First, apart from acute adrenal failure with high potassium and low sodium, less advanced functional deficiencies, which require specific explorations, may have remained undiagnosed. The second hypothesis is that immunosuppression leads to different tissular responses that are less likely to incapacitate the adrenal function. Furthermore, given the general immunosuppression, the adrenal glands no longer represent a particular niche for Histoplasma proliferation.

CLINICAL FEATURES OF THE HIV INFECTION COURSE AND THE DEPENDENCE OF CHANGES IN LABORATORY PARAMETERS ON THE CLINICAL STAGE AND ON THE CD4 LYMPHOCYTES LEVEL

The aim: Is to determine the features of the HIV infection and changes in indicators of endogenous intoxication and immunoreactivity depending on the clinical stage and the level of CD4 lymphocytes. Materials and methods: 72 HIV-patients were examined. Comparison group included 40 healthy blood donors. Clinical and laboratory examination was performed. Indicators of endogenous intoxication, nonspecific reactivity and inflammatory activity were calculated. Results:Main opportunistic infections were: oropharyngeal candidiasis; tuberculosis of different localization, more often pulmonary tuberculosis; and brain toxoplasmosis (p<0,05). Indices of endogenous intoxication and immunoreactivity are important objective criteria for diagnosis. In groups where the distribution of patients depended on the level of CD4 cells - HIV (CD4≥500) and HIV (CD4≤499-200), index changes were more pronounced than in the HIV I and HIV III groups. The most significant changes in indexes were in the HIV IV clinical group and the HIV (CD4≤199) group: endogenous intoxication indexes were increased by 1,2-7,5 and 1,9-13,7 times in both groups respectively. Non-specific reactivity indexes were decreased by 1,2-1,6 and 1,3-1,6 times, respectively; nuclear index (NI) in groups was 3 and 3,4 times higher (p<0,05-0,001). Changes in indexes of inflammatory activity were observed (p<0,05-0,001). Conclusions: Main diagnosed opportunistic infections were: oropharyngeal candidiasis; tuberculosis of different localization; and brain toxoplasmosis (p<0,05). Indices of endogenous intoxication and immunoreactivity are important objective criteria for diagnosis. The most significant changes in indexes were in the HIV IV clinical group and the HIV (CD4≤199) group (p<0,05-0,001).

Comparison of Disseminated Histoplasmosis with and without Cutaneo-Mucous Lesions in Persons Living with HIV in French Guiana.

Introduction: Histoplasmosis is the main opportunistic infection and cause of death in HIV-infected persons living with HIV in French Guiana and probably in most of Latin America. The objective of the present study was to compare cutaneomucous histoplasmosis to non-cutaneomucous histoplasmosis in French Guiana. Methods: Between 1981 and 2014 AIDS-related disseminated histoplasmosis patients followed in the three hospitals of French Guiana were retrospectively studied. Only proven incident cases of histoplasmosis, either by pathology and/or mycological analysis, were considered. Mucocutaneous histoplasmosis was ascertained by a positive mucosal or cutaneous biopsy. Results: Thirty-one patients had mucocutaneous lesions, and 318 had no mucocutaneous lesions. Patients with cutaneomucous lesions were more likely to have had prior opportunistic infections (35.5%) than those who did not have cutaneomucous lesions (19.5%). They were more likely to be very severely immunocompromised (CD4 count < 50) (90.3% versus 62.8%) and less likely to have digestive signs (32.3% versus 74.1%) and superficial adenopathies (29% versus 50.2%) than those without cutaneomucous lesions. In terms of simple biological examinations, patients with cutaneomucous lesions had fewer signs of cholestasis. The diagnosis was significantly more likely to be performed by direct examination and pathology in those with cutaneomucous lesions than in those without such lesions. On the contrary, patients with cutaneomucous lesions were less likely to be diagnosed by fungal culture than those without cutaneomucous lesions. There was a greater but non-significant risk of early death in those with cutaneomucous lesions relative to those without (OR = 2.28 (95%CI = 0.83–5.7), p = 0.056. Conclusions: Mucocutaneous forms were associated with more profound immunosuppression and perhaps risk of early death. They are easily accessible for diagnosis.

The Most Frequent Neurological Complications in HIV Patients in Constanta and the Influence that Coinfections Have in the Onset of Such Conditions

Abstract Abstract: This paper shows the results of a retrospective observational analytical study that has enrolled 166 HIV positive patients diagnosed with a neurological complication between June 2012 and June 2020, in Clinical Infectious Diseases Hospital of Constanta. 119 patients (71,69%) were diagnosed with one of the three neurological complications: HIV associated dementia (HAD), Progressive Multifocal Leukoencephalopathy (PML) and CNS Toxoplasmosis (CT). We have noted CD4 levels, viral loads, and the presence/absence of other infections like: HBV, HCV, Treponema pallidum, Mycobacterium Tuberculosis. The results show that PML and CT, in this order, are the main opportunistic infections with important neurological impact. Both, PML and CT are in direct correlation with the immune status, but also with other infections like the infection with HCV or with M. Tuberculosis. CD4 nadir &lt;100 cells/mmc and viral load ≥100000copies/ml have a stronger association with PML (p&lt;0,05). Patients known with HIV and T. pallidum infection are more likely, in case of new sudden neurological signs, to be diagnosed with Neurotoxoplasmosis versus PML, or HAD (p&lt;0,05). Given the fact that HIV patients can have multiple alterations of neurological functions, and spectaculous but complicated neuro imagistic results, knowing the history of the patients, the lab results, and the statistical probability can help the physician, infectious disease specialist or neurologist, to make a faster and precise diagnosis.

A study for precision diagnosing and treatment strategies in difficult-to-treat AIDS cases and HIV-infected patients with highly fatal or highly disabling opportunistic infections: Study protocol for antiretroviral therapy timing in AIDS patients with toxoplasma encephalitis.

Background:Toxoplasma encephalitis (TE) is one of the main opportunistic infections in acquired immunodeficiency syndrome (AIDS) patients, and represents a social burden due to its high prevalence and morbidity. Concomitant antiretroviral therapy (ART), together with effective anti- toxoplasma combination therapy, is an effective strategy to treat AIDS-associated TE (AIDS/TE) patients. However, the timing for the initiation of ART after diagnosis of TE remains controversial. We therefore designed the present study to determine the optimal timing for ART initiation in AIDS/TE patients.Methods/Design:This trial is a 17-center, randomized, prospective clinical study with 2 parallel arms. A total of 200 participants will be randomized at a 1:1 ratio into the 2 arms: the early ART initiation (≤14 days after TE diagnosis) arm and the deferred ART (>14 days after TE diagnosis) arm. The primary outcome will be the difference of mortality between the 2 arms at 48 weeks. The secondary outcomes will be the differences between the 2 arms in the changes of CD4+ counts from baseline to week 48, the rate of virologic suppression (HIV ribonucleic acid <50 copies/mL) from baseline to week 48, the incidence of TE-associated immune reconstitution inflammatory syndrome during the study period, and the incidence of adverse effects during the study period.Discussion:This present trial aims to evaluate the optimal timing for ART initiation in AIDS/TE patients, and will provide strong evidence for AIDS/TE treatment should it be successful.Trial registration:This trial was registered as one of the 12 trials under the name of a general project at the chictr.gov (http://www.chictr.org.cn/showproj.aspx?proj=35362) on February 1, 2019, and the registration number of the general project is ChiCTR1900021195.

Neurological disorders in HIV in Africa: a review.

Neurological disorders in HIV infection are a common cause of morbidity and mortality. The aim of this paper is to provide a narrative overview of up to date information concerning neurological disorders affecting HIV infected persons in Africa. Seminal research concerning neurological disorders among HIV-infected adults in sub-Saharan Africa from prior to 2000 was combined with an in-depth search of PubMed to identify literature published from 2000 to 2017. The following Mesh terms were used. "Nervous System Diseases" "HIV Infections" and "Africa South of the Sahara" and "Seizures" or "Spinal Cord Diseases" or "Peripheral Nervous System Diseases" or "AIDS Dementia Complex" or "Opportunistic Infections" or "Immune Reconstitution Inflammatory Syndrome" or "Stroke". Only those articles written in English were used. A total of 352 articles were identified, selected and reviewed and 180 were included in the study. These included case series, observational studies, interventional studies, guidelines and reviews with metanalyses. The author also included 15 publications on the subject covering the earlier phase of the HIV epidemic in Africa from 1987 to 1999 making a total of 195 references in the study. This was combined with extensive personal experience diagnosing and treating these neurological disorders. Neurological disorders were common, typically occurring in WHO stages III/IV. These were in three main categories: those arising from opportunistic processes mostly infections, direct HIV infection and autoimmunity. The most common were those arising from direct HIV infection occurring in >50%. These included HIV-associated neurocognitive dysfunction (HAND), neuropathy and myelopathy. Opportunistic infections occurred in >20% and frequently had a 6-9-month mortality rate of 60-70%. The main causes were cryptococcus, tuberculosis, toxoplasmosis and acute bacterial meningitis. Concurrent systemic tuberculosis occurred in almost 50%. Neurological disorders are common in HIV in Africa and the main CNS opportunistic infections result in high mortality rates. Strategies aimed at reducing their high burden, morbidity and mortality include early HIV diagnosis and anti-retroviral therapy (ART), screening and chemoprophylaxis of main opportunistic infections, improved clinical diagnosis and management and programme strengthening.

Characteristics of the opportunistic infections in patients with HIV-infection 3-4 stage

Objective : To analyze the main opportunistic infections group characteristic in patients with HIV-infection 3–4 stage. The article is dedicated to the basic characteristics of the related diseases that occur in the later stages of HIV infection. Ways of origin, clinical symptoms, severity and complications were discussed. According to UNAIDS not HIV-infection but associated diseases one of the leading causes of death in these patients. In the next decade, as before, these diseases will play a significant role in global average premature mortality. As it is known, a feature of HIV is to lead to the development of the opportunistic infections and multiple organ lesions on a background of progressive immunodeficiency. As a result, doctors of all specialties increasingly have to deal with various diseases of organs and systems, which can develop in patients with HIV infection. Therapy, which is intended for patients with HIV infection, is usually different. Interaction of drugs and their toxicity, high risk of serious side effects should be noted. This problem can be solved by improving prescribing schemes taking into account the features of the disease in each case specifically. Conclusions : Opportunistic infections in HIV-infected – a unique group of diseases that develop on the background of immunodeficiency state and differ significantly from other infectious diseases. The uniqueness lies in the peculiarities of clinical manifestations and requirements of the prescribed therapy. Opportunistic infections are the major cause of lesions and lethal effects in patients with HIV infection. From early diagnosis of co-infection treatment depends on the success and longevity of patients, as well as preventive measures. Tendency to multiple organ and systemic lesions require differential diagnosis with modern research techniques, including specific immunological and serological methods.

Clinical, Immunological and Virological Profile of Patients with HIV Infection on Second Line Antiretroviral Therapy

Background and Objectives: The goal of antiretroviral therapy is to maximally and durably inhibit viral replication. Objectives of this study were –  To study the various clinical features of patients on second line anti retroviral therapy.  To study the immunological and virological profile of these patients.  To study various factors determining the initiation of second line ART Material and Methodology: Retrospective analysis of 30 HIV patients on second line Antiretroviral Therapy was done. Clinical examination and various immunological profiles like CD4 count, CD8 count and virological profiles like viral load and viral resistance testing were noted if done. Details of therapy in terms of drugs, schedule, adverse effects etc. were noted. Results: Majority of patients had BMI in the normal range. Mean CD4 cell count increased from 114/mm3 at start of first line therapy to 168/mm3 at start of second line therapy. Immunological failure was the reason to switch to second line therapy in 63.33% patients. The most common second line regimen followed was Tenofovir + Abacavir + Lopinavir + Ritonavir, in 73.33% of patients, but it showed a high incidence of minor adverse effects. Viral load was estimated in 50% patients of which 36.67% patients had >20,000 HIV virus copies/ml. Tuberculosis was the main opportunistic infection encountered. Analysis and Discussion: Second line antiretroviral therapy has changed the prognosis of HIV infected patients who have first line regimen failure. The switch to second line treatment was relatively slow, due to CD4 cell count being used as the main criteria to switch therapy. This study highlights the importance of assessing viral load to monitor any early virological failure of first line ART to switch early to second line therapy. The

Pattern of Suppressed Immune Response to AIDS Infection: A Review

In AIDS patients, the main opportunistic infections are related to intracellular agents like P. carinii, cytomegalovirus, C. albicans, M. tuberculosis and criptosporidium. As in HIV infection, memory B lymphocytes keep functioning, antibodies are produced and the protection mechanism against extracellular agents does not experience large scale damage. However, this lack of greater susceptibility to extracellular bacterial infections observed in AIDS patients is observed in adults where the repertory of B-cell produced antibodies depending on T-cells had already formed prior to HIV infection. In infected children, as the alteration of TCD4+ cell functioning is premature, cellular cooperation is damaged with abnormalities also occurring in the synthesis of antibodies. Infections by extracellular bacteria are common in HIV-infected children.

Getting health services to three million people with TB

Tuberculosis (TB) is the second leading cause of mortality associated with infectious diseases globally and the leading cause of death among people living with HIV. In 2010, there were an estimated nine million people with TB – a third of whom do not have access to TB services – and approximately 1.5 million deaths were attributed to this disease. Moreover, TB is the main opportunistic infection in certain areas, such as Eastern Europe and Central Asia; here, infections are still increasing. Although antiretroviral therapy reduces mortality, there is a need to provide guidelines on the pharmacological interactions between antiviral drugs and drugs used for treating TB. This year, the STOP TB PARTNERSHIP is focusing on diagnosis, treatment and cure for all. (Published: 24 March 2014) Citation: Perez H. Journal of the International AIDS Society 2014, 17 :19079 http://www.jiasociety.org/index.php/jias/article/view/19079 | http://dx.doi.org/10.7448/IAS.17.1.19079

Assessment of Five Years’Comprehensive Management of HIV-Infected Children in Parakou

Introduction: The Pediatric Unit of the Borgou Regional Hospital (CHD-Borgou) in Parakou has initiated treating HIV-infected children with Anti-Retroviral (ARV) drugs since 2005. This study aimed to describe the profile and the future of the HIV-infected children who were provided medical care at the Pediatric Unit of the CHD-Borgou from 2005 to 2009. Patients and methods: It is a retrospective study with descriptive and analytical objective, carried out from January 2005 to December 2009 on 105 HIV-infected children from both sexes cared in that Unit. Results: HIV infection represented 0.43% of the children brought for medical examination during the study period. Among these children, 82.9% were at clinical stages 3 or 4 on inclusion into patient panel and 76.2% had severe immunodeficiciency. The proportion of children on Anti-Retroviral Therapy (ART) was 69.1%. The main opportunistic infections found were digestive (30.3%), pulmonary (28.5%), dermatological (24.1%) and ENT (10.5%) ones. The problems identified included lack of early diagnostic tools, frequent shortage of antiretroviral drugs, treatment or therapeutic failures, causes related to poor compliance and follow up. The lost of follow up rate was 39%. Death rate was 33.3%. Death was significantly associated with the advanced clinical stage of disease on admission (p=0.002), with age at the time of screening (p=0.017) and with follow up duration (p=0.000). Conclusion: Despite the difficulties noted, this study showed that, in limited resources settings like ours, it is possible to improve the clinical outcome of HIV infected children. The high mortality rate noted related to the delayed HIV diagnosis can be reduced by strengthening the Prevention of Mother to Child Transmission (PMTCT) program.

Infections opportunistes du VIH/sida chez les adultes en milieu hospitalier au Togo

The objective of this study is to determine the main opportunistic infections (OI) and those strongly linked to high death rate in hospital settings in Togo. It is a descriptive study conducted from June to November 2008 in 22 public and private settings of all medical specialties throughout the entire Togolese territory. Hospitalized patients with OI and HIV positive data were collected. The study was started after getting patient approval. Of 7,361 hospitalized patients, 1,764 were tested, giving a screening rate of 23.7%. We registered 714 HIV-infected patients (HIVIP), 40.5% of the patients tested. The most common OI encountered were buccal candidiasis (49.7% of HIVIP), genital candidiasis (9.1%), meningeal cryptococcosis (2.9%), bacterial infections (48.2%), cerebral toxoplasmosis (11.2%) and pulmonary tuberculosis (11.3%). OI strongly linked to a high death rate were meningeal cryptococcosis (61.9%) and cerebral toxoplasmosis (46.3%). OI constitute a major reason of hospitalization for HIVIP in Togo. This study allows a better orientation of strategies for screening and taking care of HIVIP in Togo.

HIV and the nervous system

Neurological complications are common in patients with HIV-1, and occur as a primary manifestation of HIV, such as encephalopathy or myelopathy, as a result of concomitant immunosuppression, or due to adverse effects of treatment. These complications substantially contribute to morbidity and mortality, even in the era of highly active antiretroviral therapy (HAART) and are thus still an important issue, particularly as the nervous system is now known to be the first organ affected in this infection, and the presentation, outcome, and incidence has changed since the introduction of multitherapies with protease inhibitors.In Spectrum of Neuro-AIDS Disorders, Goodkin and coeditors, with more than 90 contributors, offer a book that, in 36 chapters, is an up-to-date review of the most important aspects of these complications. The main feature is that each chapter bridges the literature from the earlier results in the pre-HAART era to the current knowledge and hypotheses, representing a unique compilation of years of investigative research. Inevitably, such a number of contributors leads to a problem with balance: chapters are unequal and data are sometimes splintered all over the book.A full understanding of some of the topics will demand deep reading. Of the six main parts, the first two are devoted to disorders caused by primary HIV-1 pathogenesis in the CNS. Several chapters are dedicated to the different aspects of HIV-1 cognitive disorders and encephalopathy (notably pathophysiology and clinical diagnosis) and offer an exceptional review of past and current controversies. Stroke, myelopathy, myopathy, and neuropathies are also discussed. The third section focuses on neuroimaging and new diagnostic tools such as spectroscopy and functional MRI, and the fourth part covers the main opportunistic infections, co-infection with hepatitis C virus, and other comorbidities such as psychiatric disorders. Interestingly, addiction is also classified as a comorbidity; the abuse of any substance (alcohol and anabolic steroids included) might worsen a weak nervous system. The last two parts describe complications in specific populations, such as in paediatric AIDS or in patients over 50 years, and these sections also cover specific concerns, such as palliative care or medico-legal matters.Although deficient in some areas (eg, a chapter on immune restoration inflammatory syndrome would have been welcome, Spectrum of Neuro-AIDS Disorders is a comprehensive compendium enabling readers to develop a foundation of knowledge on which future information can be added. Neurological complications are common in patients with HIV-1, and occur as a primary manifestation of HIV, such as encephalopathy or myelopathy, as a result of concomitant immunosuppression, or due to adverse effects of treatment. These complications substantially contribute to morbidity and mortality, even in the era of highly active antiretroviral therapy (HAART) and are thus still an important issue, particularly as the nervous system is now known to be the first organ affected in this infection, and the presentation, outcome, and incidence has changed since the introduction of multitherapies with protease inhibitors. In Spectrum of Neuro-AIDS Disorders, Goodkin and coeditors, with more than 90 contributors, offer a book that, in 36 chapters, is an up-to-date review of the most important aspects of these complications. The main feature is that each chapter bridges the literature from the earlier results in the pre-HAART era to the current knowledge and hypotheses, representing a unique compilation of years of investigative research. Inevitably, such a number of contributors leads to a problem with balance: chapters are unequal and data are sometimes splintered all over the book. A full understanding of some of the topics will demand deep reading. Of the six main parts, the first two are devoted to disorders caused by primary HIV-1 pathogenesis in the CNS. Several chapters are dedicated to the different aspects of HIV-1 cognitive disorders and encephalopathy (notably pathophysiology and clinical diagnosis) and offer an exceptional review of past and current controversies. Stroke, myelopathy, myopathy, and neuropathies are also discussed. The third section focuses on neuroimaging and new diagnostic tools such as spectroscopy and functional MRI, and the fourth part covers the main opportunistic infections, co-infection with hepatitis C virus, and other comorbidities such as psychiatric disorders. Interestingly, addiction is also classified as a comorbidity; the abuse of any substance (alcohol and anabolic steroids included) might worsen a weak nervous system. The last two parts describe complications in specific populations, such as in paediatric AIDS or in patients over 50 years, and these sections also cover specific concerns, such as palliative care or medico-legal matters. Although deficient in some areas (eg, a chapter on immune restoration inflammatory syndrome would have been welcome, Spectrum of Neuro-AIDS Disorders is a comprehensive compendium enabling readers to develop a foundation of knowledge on which future information can be added.