Management Of HIV-infected Patients Research Articles

Human Immunodeficiency Virus: Opportunistic Infections and Beyond.

Human immunodeficiency virus (HIV) infection causes substantial morbidity and mortality worldwide. Although antiretroviral therapy (ART) has changed the epidemiology of HIV in the last 20 years with increased survival and decreasing incidence of opportunistic infections (OI), CNS OI remain a major cause of morbidity. Improved survival has also increased neurological presentations due to co morbid conditions, treatment related side effects and inflammatory syndromes. Being familiar with the imaging findings, the impact of ART and interpretation of imaging in the context of clinical and laboratory findings is important for radiologists as well as clinicians in the management of HIV-infected patients.

HIV Patients’ Tracer for Clinical Assistance and Research during the COVID-19 Epidemic (INTERFACE): A Paradigm for Chronic Conditions

The health emergency linked to the SARS-CoV-2 pandemic has highlighted problems in the health management of chronic patients due to their risk of infection, suggesting the need of new methods to monitor patients. People living with HIV/AIDS (PLWHA) represent a paradigm of chronic patients where an e-health-based remote monitoring could have a significant impact in maintaining an adequate standard of care. The key objective of the study is to provide both an efficient operating model to “follow” the patient, capture the evolution of their disease, and establish proximity and relief through a remote collaborative model. These dimensions are collected through a dedicated mobile application that triggers questionnaires on the basis of decision-making algorithms, tagging patients and sending alerts to staff in order to tailor interventions. All outcomes and alerts are monitored and processed through an innovative e-Clinical platform. The processing of the collected data aims into learning and evaluating predictive models for the possible upcoming alerts on the basis of past data, using machine learning algorithms. The models will be clinically validated as the study collects more data, and, if successful, the resulting multidimensional vector of past attributes will act as a digital composite biomarker capable of predicting HIV-related alerts. Design: All PLWH > 18 sears old and stable disease followed at the outpatient services of a university hospital (n = 1500) will be enrolled in the interventional study. The study is ongoing, and patients are currently being recruited. Preliminary results are yielding monthly data to facilitate learning of predictive models for the alerts of interest. Such models are learnt for one or two months of history of the questionnaire data. In this manuscript, the protocol—including the rationale, detailed technical aspects underlying the study, and some preliminary results—are described. Conclusions: The management of HIV-infected patients in the pandemic era represents a challenge for future patient management beyond the pandemic period. The application of artificial intelligence and machine learning systems as described in this study could enable remote patient management that takes into account the real needs of the patient and the monitoring of the most relevant aspects of PLWH management today.

Monoclonal antibodies for prevention or treatment of HIV-1infection: what next after the first clinical trials?

The therapeutic revolution of monoclonal antibodies is spreading to the field of infectious diseases. After many years of academic research to isolate and characterize the first HIV-neutralizing antibodies, a few molecules are entering the final stages of clinical trials and the industrial development pipelines of several pharmaceutical companies. These neutralizing antibodies, also known as bNAbs (broadly neutralizing antibodies), have a broad spectrum of activity, allowing us to hope for pan-genotypic or near pan-genotypic efficacy, a sine qua non for lasting antiviral efficacy. Following the failures of the different vaccine strategies tried until now, what can neutralizing antibodies offer us in the prevention of HIV infection? Can these biotherapies find their place in the management of HIV-infected patients? This article will shed light on recent data from clinical trials of the main anti-HIV neutralizing antibodies in development for use in prophylaxis and therapy.

Comparison of clinical and biological characteristics of HIV-infected patients presenting Cryptococcus neoformans versus C. curvatus/C. laurentii meningitis

BackgroundCryptococcal meningitis is mainly caused by Cryptococcus neoformans/C. gattii complex. We compared the clinical, biological, and antifungal susceptibility profiles of isolates from HIV-Infected Patients (HIVIP) with C. neoformans (Cn) versus C. curvatus/C. laurentii (Cc/Cl) meningitis.MethodsComparative analytical study were conducted. Apart from patients’ clinical data, the following analysis were performed and the results were compared in both groups: biochemical examination, cryptococcal antigen test, India ink staining, and culture on Cerebral Spinal Fluid (CSF), strains identification by mass spectrometry, ITS sequencing, PCR serotyping and antifungal susceptibility. The main outcome variable was the “species of Cryptococcus identified”, which was compared to other variables of the same type using the Pearson Chi-square test or the Fisher exact test.ResultsA total of 23 (79.3%) Cn meningitis cases versus 6 (20.7%) Cc/Cl meningitis were retained.Cn meningitis was more frequently associated with headache (100% vs 50%, p = 0.005) than Cc/Cl meningitis and meningeal signs were more frequent in Cn infected patients. Biologically, hypoglycorrhachia and low CD4 count were more observed in Cn group (90% vs 20% of patients, p = 0.01; 45.6 vs 129.8 cells/µL, p = 0.02, respectively). A higher proportion of Cn strains (91.3%) showed a low Minimum Inhibitory Concentration (MIC) (< 8 mg/L) for fluconazole compared to Cc/Cl strains (66.7%). Also, Cc/Cl strains resistant to 5-flucytosine and amphotericin B were found in 16.7% of cases for each of the two antifungal agents. Cryptococcus detection by routine analysis (India ink, culture, and antigens) was better for Cn samples than Cc/Cl. Except ITS sequencing, which identified all strains of both groups, mass spectrometry and serotyping PCR identified Cn strains better than Cc/Cl (100% vs 80%, p = 0.1; 100% vs 0%, p < 0.0001, respectively). After treatment with amphotericin B, 5-flucytosine, and fluconazole in both groups, the outcome was similar.ConclusionsClinical presentation of Cn meningitis is certainly more severe than that of Cc/Cl meningitis, but Cc/Cl infection should be considered in the management of HIVIP with meningeal syndrome because of the diagnostic difficulty and the high MICs of antifungal agents required for the treatment of meningitis due to these cryptococcal species.

Nine ideas to improve the clinical management of HIV infected patients during the COVID-19 pandemic

SummaryGlobally, in 2019, HIV infection was still responsible for 1.7 million new infections and for 690,000 deaths in the same year. Tailored and new antiretroviral therapy (ART) regimens, individualised follow-up and new technologies to support data-sharing between health-care professional caring for people living with HIV (PLHIV) and to deliver ART to patients are desperately needed to reach the 90-90-90-90 ambitious goals. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, responsible for the Coronavirus-19 (COVID-19) pandemic that spread globally in 2020, posed a huge challenge for PLHIV and HIV physicians worldwide in terms of continuum of care. In this paper we encourage “up-to-date patient-centred HIV medicine” and we give nine ideas to improve HIV management in clinical practice during the COVID-19 pandemic.

ASSESSMENT OF THE ROLE OF COMMUNITY PHARMACISTS IN MANAGEMENT OF HIV-POSITIVE INDIVIDUALS IN THE SOUTHERN REGION OF NIGERIA

Background: The long- recognized challenges to HIV care remained relevant as newer challenges emerge. Pharmacists’ role has evolved and expanded to help patients and other healthcare providers to achieve the core goals of HIV management. Objectives: this study assessed the role/services community pharmacists play/offer in the management of HIV patients in Rivers State, Southern region of Nigeria, and evaluated the perception of community pharmacists towards management of HIV infected patients. Method: A cross-sectional study was carried out among three hundred and seventy- four community pharmacist- owned pharmacies spread across Rivers State. Data were collected using pre-tested structured questionnaire. The structure comprises (1) demographic information (2) services offered to HIV infected patients (3) perception towards community pharmacists’ involvement in management of HIV. Data were analyzed with SPSS version 16 and statistical significance taken at p&lt;0.05. Results: Out of 374 (100%) community pharmacist-owned pharmacies only 30 (8%) were involved in the management of HIV patients. 22(73.3%) were male and 8(26.7%) were female. While 23(76.7%) had B.Pharm degree; 2(6.7%) had Pharm D. 18(70%) had 11 – 20yrs practice experience as 7(23%) had over 20 yrs experience. 23(76.6%) had special HIV training program while 3(10%) self-acquired information on HIV. The Likert scale to measure perception is biased towards agreement, Likert scale 3.89, that community pharmacists are knowledgeable and well positioned to play role in the management of HIV infected patients. Conclusion: Very few 30(8%) of registered community pharmacists are involved in the management of HIV patients. Although the services offered cut across the guidelines for management of HIV infected patients, there is still need for improvement and regular update on HIV training for community pharmacists. These steps would help to involve more community pharmacists, decongest hospitals and reduce workload on hospital pharmacists. Peer Review History: Received 23 January 2021; Revised 5 February; Accepted 26 February, Available online 15 March 2021 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewer(s) detail: Prof. Dr. Hassan A.H. Al-Shamahy, Sana'a University, Yemen, shmahe@yemen.net.ye Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, ahsndkyc@gmail.com Similar Articles: AWARENESS OF PHARMACISTS TOWARDS ASPARTAME SIDE EFFECTS IN KHARTOUM CITY, SUDAN SUDANESE PHARMACY STUDENTS: CAREER INTENTIONS, EXPECTATIONS AND FACTORS AFFECTING THEIR CHOICES

Prevalence of chronic kidney disease among HIV-infected adults on antiretroviral therapy in northern Namibia: a cross-sectional study

Introduction: There is an epidemic of chronic kidney disease (CKD) in Africa and human immunodeficiency virus (HIV) infection is among the major drivers. However, the burden of CKD in HIV-infected patients in Africa varies widely by country and study, ranging from 0.5–59.3%. Published data on the prevalence of CKD in the Namibian HIV-infected population are scarce. In this study, we aimed to estimate the prevalence of CKD and associated factors in HIV-infected adults on antiretroviral therapy in northern Namibia. Methods: We conducted a cross-sectional study in the four regions of northern Namibia, using existing electronic records used in the management of HIV-infected patients. Variables captured included the two most recent serum creatinine measurements, date of birth, sex, date of initiating antiretroviral therapy, current antiretroviral treatment, and most recent HIV viral load results. We used standardised serum creatinine measurements to estimate the glomerular filtration rate (GFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. CKD was defined as estimated GFR (eGFR) &lt; 60 mL/min/1.73 m2 on two occasions at least three months apart. Factors associated with CKD were assessed using logistic regression. Results: We included 1 993 participants, of whom 1 362 (68%) were female and mean age was 44.5 ± 11.5 years.The proportion of participants who were virally suppressed was 97% (95% CI 96, 98%) and the median durationon antiretroviral therapy was 107 months (IQR 62–149). The prevalence of CKD was 1.4% (95% CI 1.0, 2.0%).CKD cases were 13 times more likely to be 45 years or older and 3.5 times more likely to be male than those without CKD. Conclusions: Our findings suggest a low prevalence of CKD among the HIV-infected population in northern Namibia. Patients older than 45 years may need additional monitoring for kidney function using eGFR.

The use of computer techniques to optimize the diagnosis of tuberculosis in HIV-infected patients at the secondary diseases stage

ВACKGROUND: The course of tuberculosis in HIV-infected patients has no significant clinical and diagnostic differences from damage to organs and systems of other etiology. The growth of new cases of HIV/TB co-infection necessitates a revision of diagnostic approaches, their improvement in order to increase the efficiency of examination and management of HIV-infected patients, depending on the stage and indicators of the immune status.&#x0D; AIM: Of the study was to determine by the method of complex statistical processing the main clinical and laboratory-instrumental criteria for improving the diagnosis of tuberculosis in HIV-infected patients at the stage of secondary diseases.&#x0D; MATERIALS AND METHODS: The study design was retrospective. The object of the research was the case histories of 113 patients with HIV infection at the stage of secondary diseases (classification by V.I. Pokrovsky), of parametric and nonparametric statistics, computer analysis of images with the gradient program proposed by Dr. Sci. A.N. Gerasimov, to assess the possibility of using micro- and macro-preparations of tissues and organs of patients with HIV infection.&#x0D; RESULTS: Using the method of correlation adaptometry, it was found that there are no significant differences in the clinical course of HIV-infected patients with tuberculosis of various localization, and with lesions of the respiratory organs of other etiology. The use of multivariate probability models made it possible to identify significant diagnostic risk factors for lethal outcome ― 66.7% of patients with further lethal outcome complained of chest pain during breathing (p=0.004), and ESR was significantly accelerated in patients with a lethal outcome in the hospital ― 771.99 (p=0.019).&#x0D; CONCLUSION: The multicomplex instrumental and laboratory examination makes it possible to diagnose tuberculosis of various localization at the initial stage of development. The use of computer techniques optimizes and unifies the diagnostic search in patients with HIV infection and determines the timely treatment tactics.

Justification of the integrated approach to management of hiv-infected patients with comorbid pathology of the digestive system

Introduction. Among the main strategic and operational goals of the State Strategy for Combating HIV / AIDS, Tuberculosis and Viral Hepatitis by 2030 in Ukraine is to ensure comprehensive access to HIV treatment, increase the effectiveness of monitoring and support of treatment of both opportunistic infections and other somatic conditions in HIV-infected patients. The key role of family physicians in the detection and treatment of many chronic gastrointestinal complications in HIV-infected patients is recognized.&#x0D; Purpose of the study. To increase the efficiency of early diagnosis and tactics of integrated management of HIV-infected patients of family physicians (FP) by clarifying the peculiarities of HIV infection in the presence of comorbid pathology of the digestive system (DS) and creating an algorithm for providing medical care to these patients.&#x0D; Material and methods. The research was conducted on the basis of five regional HIV / AIDS centers of Ukraine during 2017-2019. Randomly selected 342 adult HIV-infected patients were divided into two groups - with concomitant lesions and without concomitant gastrointestinal lesions. The following research methods were used: general clinical and laboratory biochemical, molecular genetic, immunological, enzyme-linked immunosorbent, instrumental (FGDS, chest radiography, abdominal ultrasound, computed tomography of the chest and / or abdominal cavity), analysis of primary medical records, consultations related specialists according to the indications, questionnaires, statistical methods.&#x0D; Results and discussion. It was found that the incidence of gastrointestinal pathology in patients with II, III and IV clinical stages of HIV infection was significantly higher than in patients with stage I, significantly more often associated with tuberculosis, candidiasis, kidney disease and HIV encephalopathy and was combined. Manifestations of asthenovegetative and dyspeptic syndromes, weight loss, anemia and leukopenia, increased activity of liver enzymes, low levels of CD4 + lymphocytes and preservation of viral load on antiretroviral therapy were significantly more common in HIV-infected patients with gastrointestinal pathology. In the presence of pathology of the digestive system, replacements, breaks and side effects of antiretroviral therapy were significantly more frequent. The results of physicians survey analysis showed the role of family physicians in the current examination and management of HIV-infected people with comorbid pathology of the digestive system.&#x0D; Conclusions. To detect diseases of the organs of the DS in HIV-infected people, it is necessary to conduct a comprehensive laboratory and instrumental examination, taking into account the possibility of combined pathology. The proposed algorithm of integrated management of HIV-infected patients with comorbid pathology of DS by FPs, taking into account the most informative clinical and laboratory criteria, allows to increase the effectiveness of early diagnosis and tactics of integrated management of HIV-infected by FPs.

La santé mentale des patients vivant avec le VIH dans le service des maladies infectieuses du CHU Casablanca, Maroc

BackgroundSince the advent of antiretroviral therapy and the increase in life expectancy of patients, mental health has become a concern for both PLWHIV and caregivers. The objective of our work is to estimate the prevalence of psychiatric disorders, to study the nature of these disorders and to identify socio-demographic and medical risk factors influencing the mental health of PLWHIV. Patients and methodsDescriptive cross-sectional study carried out in the Department of Infectious Diseases from January 2015 to November 1015 on HIV-infected patients seen in the day hospital and presenting with psychiatric disorders. The data were collected on the farm records and analyzed on Excel. ResultsThe prevalence of the disorders is 3.39%. The average age is 39.28 years (24–58 years). The female sex predominates (sex ratio : 0.62). Most patients are illiterate or have a primary education (63%), have a job (67%). Twelve patients (17%) had a psychiatric history and 42 patients (61%) had disorders during follow-up. Psychiatric disorders are dominated by depression (87%) and anxiety (29%). The alleged sources of the disorders are material precariousness (84%), divorce (30%), loss of work (29%). The mode of contamination is mainly heterosexual (87%). The median duration of HIV infection is 3 years (1 month-18 years). The majority of patients (77%) are on antiretroviral therapy, 64% have CD4 lymphocytes <200/mm3 and 30% are in virological failure. Forty-one percent reported an impact on sexuality and 29% on adherence to treatment. Psychotropic drugs were prescribed in 87% of cases and 36% benefited from accompanying psychotherapy. Stabilization is achieved in 36% of patients. ConclusionPsychiatric manifestations are frequent during HIV infection. They are dominated by depression and are responsible for therapeutic failure, hence the need for collaboration between psychiatrist and infectiologist in the management of HIV-infected patients.

Prevalence of hepatitis B and delta according to HIV-type: a multi-country cross-sectional survey in West Africa

BackgroundIn West Africa where HIV-1 and HIV-2 co-circulate, the co-infection with hepatitis B virus (HBV) and hepatitis Delta virus (HDV) is not well described. This study aimed at estimating the prevalence of HBV and HBV/HDV co-infection according to HIV types and risk factors for HBV infection among West African HIV-infected patients.MethodA cross-sectional survey was conducted within the IeDEA West Africa cohort from March to December 2012 in Côte d’Ivoire (three sites), Burkina Faso and Mali (one site each). All HIV-infected adult patients on antiretroviral therapy (ART) or not who attended one of the participating HIV clinics during the study period and agreed to participate were included. Blood samples were collected and re-tested for HIV type discrimination, HBV and HDV serology as well as HBV viral load. Logistic regression was used to identify risk factors for HBV infection.ResultsA total of 791 patients were included: 192 HIV-1, 447 HIV-2 and 152 HIV-1&2 dually reactive. At time of sampling, 555 (70.2%) were on ART and median CD4+ cell count was 472/mm3 (inter-quartile range [IQR]: IQR: 294–644). Sixty-seven (8.5%, 95% CI 6.6–10.6) patients were HBsAg positive without any difference according to HIV type (7.9% in HIV-1, 7.2% in HIV-1&2 dually reactive and 9.4% in HIV-2; p = 0.61). In multivariate logistic analysis, age ≤ 30 years old (adjusted odds ratio [aOR] 5.00, 95% CI 1.96–12.76), age between 31 and 49 years old (aOR 1.78, 95% CI 1.00–2.21) and male gender (aOR 2.15, 95% CI 1.25–3.69) were associated with HBsAg positivity. HBV DNA testing was performed in 36 patients with blood sample available (25 on ART) and 8 (22.2%) had detectable HBV DNA. Among the HBsAg-positive individuals, 14.9% (95% CI 7.4–25.7) were also positive for anti-HDV antibody without any difference according to HIV type (28.6% in HIV-1, 14.3% in HIV-2 and 0.0% in HIV-1&2 dually reactive; p = 0.15).ConclusionHBV and HBV/HDV co-infection are common in West Africa, irrespective of HIV type. Therefore, screening for both viruses should be systematically performed to allow a better management of HIV-infected patients. Follow-up studies are necessary to determine the impact of these two viruses on HIV infection.

Non-adherence to anti-retroviral therapy among HIV infected adults in Mon State of Myanmar

BackgroundThe provision of Anti-Retroviral Therapy (ART) was started in Myanmar in 2005 in collaboration with the National AIDS Program and the private sector. Successful clinical management of HIV-infected patients is subject to optimal adherence. The aim of the study was to determine the prevalence of adherence to ART and identify factors associated with non-adherence to ART among HIV infected adults registered in a private sector setting in Mon State, Myanmar.MethodsThis cross-sectional study was conducted with adults living with HIV receiving ART at an HIV outpatient clinic between April and May 2016. A total of three hundred People Living with HIV(PLHIV) were interviewed using a pretested and structured questionnaire. The 30 days Visual Analog Scale (VAS) adherence instrument was used to assess the level of adherence. Multivariable logistic regression analysis was used to determine factors associated with non-adherence to ART.ResultsAmong 300 patients (male 37.7% and female 62.3%, with a mean age of 41.3 years, standard deviation 8.7), 84% reported ≥95% adherence to ART in the past month. Among 16% of those reporting non-adherence, major reasons for skipping the medication were being busy (23%), being away from home (17.7%) and being forgetful (12.3%). In multivariable logistic rgeression, low behavioural skills on ART adherence (OR = 0.31, 95% CI: 0.10-0.94), tobacco use (OR = 3.22, 95% CI:1.28-8.12), having disclosed their HIV status (OR = 0.07, 95% CI: 0.01-0.69), having a partner who was not on ART (OR = 4.25, 95% CI: 1.70-10.64) and among men, having erectile dysfunction (OR = 15.14, 95% CI: 1.41-162.66) were significant associated with ART non-adherence.ConclusionNon-adherence to ART was associated with individual moderating factors and behavioral skills. Priority measures such as addressing risk behaviour and behavioural change communication tailored to individual patients’ lifestyles requires comprehensive interventions to improve adherence.

A Mature NK Profile at the Time of HIV Primary Infection Is Associated with an Early Response to cART.

Natural killer (NK) cells are major effectors of the innate immune response. Despite an overall defect in their function associated with chronic human immunodeficiency virus (HIV) infection, their role in primary HIV infection is poorly understood. We investigated the modifications of the NK cell compartment in patients from the ANRS-147-Optiprim trial, a study designed to examine the benefits of intensive combination antiretroviral therapy (cART) in patients with acute or early primary HIV infection. Multiparametric flow cytometry combined with bioinformatics analyses identified the NK phenotypes in blood samples from 30 primary HIV-infected patients collected at inclusion and after 3 months of cART. NK phenotypes were revealed by co-expression of CD56/CD16/NKG2A/NKG2C and CD57, five markers known to delineate stages of NK maturation. Three groups of patients were formed according to their distributions of the 12 NK cell phenotypes identified. Their virological and immunological characteristics were compared along with the early outcome of cART. At inclusion, HIV-infected individuals could be grouped into those with predominantly immature/early differentiated NK cells and those with predominantly mature NK cells. Several virological and immunological markers were improved in patients with mature NK profiles, including lower HIV viral loads, lower immune activation markers on NK and dendritic cell (DC), lower levels of plasma IL-6 and IP-10, and a trend to normal DC counts. Whereas all patients showed a decrease of viremia higher than 3 log10 copies/ml after 3 months of treatment, patients with a mature NK profile at inclusion reached this threshold more rapidly than patients with an immature NK profile (70 vs. 38%). In conclusion, a better early response to cART is observed in patients whose NK profile is skewed to maturation at inclusion. Whether the mature NK cells contributed directly or indirectly to HIV control through a better immune environment under cART is unknown. The NK maturation status of primary infected patients should be considered as a relevant marker of an immune process contributing to the early outcome of cART that could help in the management of HIV-infected patients.

A CHALLENGING NEUROLOGICAL COMPLICATION IN A YOUNG HIV-INFECTED WOMAN

Background: The management of HIV infected patients with immune reconstitution inflammatory syndrome (IRIS) represents a challenge, especially in those with cerebral opportunistic infections. Case description: We present a 26 year-old woman, diagnosed with HIV infection and admitted in our hospital with severe anemia, depression and anxiety. Lab screens showed severe anemia and immunosuppression (CD4 cell count 63 cells/mm3 ) and high plasma HIV-RNA (6.25 log10 copies/mL). After one month treatment with lamivudine 3TC, tenofovir (TDF) and raltegravir RAL and important immune recovery (CD4 192 cells/mm3 ) and significant decay in HIV viral load to 1.5 log10 copies/mL were noticed. The initial clinical evolution was unfavorable with the appearance of generalized seizures, movement disturbances, auditory hallucinations and right hemiparesis. CSF exam was normal with negative bacterial and fungal cultures but with detectable HIV-RNA – 82 copies/mL (1.90 log10 copies/mL). Brain MRI showed hyperintense lesions on T2 and FLAIR sequences and hypointense on T1 sequences, localized in fronto-temporal areas, right cerebellum and pons. In evolution, there was a continuing worsening of psychiatric and neurological symptoms with severe tremor, axial hypotonia, generalized weakness and severe sleep disturbances. Atypical brain MRI lesions in the presence of severe psychiatric symptoms raised difficulties in establishing the cause of the neurological complication. The important progression of the lesion in the white matter, the appearance of contrast enhancement and the presence of JC – DNA in CSF suggested the diagnosis of PML IRIS. The patient was treated with high doses of cortisone, antipsychotic drugs and continued cART, with a slow clinical recovery and brain MRI improvement starting with 4 months of treatment. Conclusion: The diagnosis of the neurological complication was difficult due to the atypical onset, the presence of concomitant psychiatric symptoms and the atypical initial brain imaging.

English

The rebirth to seven wonders (R7M) powder supplement was used for nutritional management of HIV-infected patients. The powder is a multipurpose powder used as a food supplement in human foods because of its nutritional qualities. It has many uses such as in the fight against malnutrition in Cote d’Ivoire because of its nutritional qualities. The purpose of this study was to evaluate the effect of supplementation of the “R7M” powder consumption on the clinical evolution and the laboratory findings in people living with HIV/AIDS and on antiretroviral treatment. The present work is focused on biochemical analysis and monitoring of some anthropometric and laboratory parameters. The biochemical analysis of the powder showed that 100 g of powder contains 54.02 g of carbohydrate, 7.6 g of fat and 31.25 g of proteins. The same amount of powder contains minerals such as magnesium (149.25 mg), calcium (77.5 mg), zinc (3.25 mg) and iron (47.5 mg). After six months of using the “R7M” powder among both groups, anthropometric parameter (weigh) and biological parameters (creatine, hemoglobin and CD4 count) were measured. Nutritional recovery with the “R7M” powder showed an improvement in the main follow-up criteria, that is, weight, hemoglobin, creatine and CD4 count in both groups. This improvement was significantly increased in HIV group with antiretroviral (ARV) treatment. This study confirms the nutritional properties of the “R7M” powder which can be used as food supplement in the fight against protein-energy malnutrition and micronutrient deficiencies. Key words: Powder, rebirth to seven wonders, nutrition, HIV, food supplement.

Association of knowledge on ART line of treatment, scarcity of treatment options and adherence.

BackgroundAdherence to Antiretroviral Therapy (ART) is critical piece in the management of HIV infected patients. Despite the benefits of ART, non-adherence to ART persists. This study explores association between patient’s knowledge of the ART line of treatment, availability of future treatment options and adherence.MethodsA cross sectional survey of HIV infected adolescent and adults was conducted. Cumulative optimal and sub-optimal adherence was defined as percentage adherence of ≥ 95 % and < 95 %, respectively. Binomial regression models were used to assess the association of patient’s knowledge of the ART line of treatment, availability of future treatment options and adherence.ResultsOf the 402 patients reviewed, 101 (25.1 %) patients knew their ART line of treatment and were aware that future treatment options are limited. Compared to those who were not aware of the ART line of treatment and/or scarcity of future treatment options, those who were aware were more likely to be adherent (adjusted prevalence ratio [APR], 1.1; 95 % CI, 1.0–1.3).ConclusionThe study reports knowledge of patient’s ART line of treatment and future treatment options is important indicator of adherence to ART. Although majority of the patients did not have the knowledge, those who had the knowledge demonstrated to be more adherent. It is critical for the physicians/health care providers in these settings to clearly educate patients about ART line of treatment and limited availability of future treatment options as such information is likely to influence individual behavior and improve patient’s adherence to ART.

A piecewise model of virus-immune system with two thresholds

The combined antiretroviral therapy with interleukin (IL)-2 treatment may not be enough to preclude exceptionally high growth of HIV virus nor rebuilt the HIV-specific CD4 or CD8 T-cell proliferative immune response for management of HIV infected patients. Whether extra inclusion of immune therapy can induce the HIV-specific immune response and control HIV replication remains challenging. Here a piecewise virus-immune model with two thresholds is proposed to represent the HIV-1 RNA and effector cell-guided therapy strategies. We first analyze the dynamics of the virus-immune system with effector cell-guided immune therapy only and prove that there exists a critical level of the intensity of immune therapy determining whether the HIV-1 RAN virus loads can be controlled below a relative low level. Our analysis of the global dynamics of the proposed model shows that the pseudo-equilibrium can be globally stable or locally bistable with order 1 periodic solution or bistable with the virus-free periodic solution under various appropriate conditions. This indicates that HIV viral loads can either be eradicated or stabilize at a previously given level or go to infinity (corresponding to the effector cells oscillating), depending on the threshold levels and the initial HIV virus loads and effector cell counts. Comparing with the single threshold therapy strategy we obtain that with two thresholds therapy strategies either virus can be eradicated or the controllable region, where HIV viral loads can be maintained below a certain value, can be enlarged.

Management of HIV Infected Patients with Active Buruli Ulcer in Tropical Regions in Africa, a New Therapeutic Challenge: A Review

Management of HIV Infected Patients with Active Buruli Ulcer in Tropical Regions in Africa, a New Therapeutic Challenge: A Review

Profil clinique, paraclinique et évolutif du sujet infecté par le VIH comparé à celui du sujet non infecté par le VIH en milieu pneumologique hospitalier à Abidjan

The HIV infection is a problem of public health in Côte d'Ivoire. Voluntary screening is encouraged for the premature management of HIV infected patients before the stage of serious opportunist affections. Antiretroviral therapy became free. The purpose of this study was to describe the characteristics of HIV infected subject infected in hospitalization of pneumology. Our retrospective and analytic study concerned the activity period from January 2001 to December 2012 of pneumology department of Cocody university hospital. On 1141 recorded files, the prevalence of HIV infection was 48.20%. The multi-varied analysis showed the following results. Male patients were less HIV infected (OR=0.490 [0.363-0.661]) as the old patients of more than 64 years (OR=0.150 [0.080-0.280]). In case of HIV infection, infectious pathology, severe anemia and renal insufficiency were dominating respectively with OR=1.763 (1.212-2.564), OR=3.167 (2.125-4.720) and OR=2.054 (1.335-3.161). A stronger mortality was associated with HIV infection (OR=1.920 [1.312-2.809]). HIV infection always remains frequented in pneumology hospitalization in Abidjan with late discovery, source of complications and abnormally high death rate.

Cancer incidence in HIV patients under HAART therapy in a HIV-1 F1 subtype endemic area

Abstract Cancers have been recognized as a major health problem in patients with HIV. The first cases reported, before the existence of the virus was proven, involved patients with immunosuppression and a history of illness characterized by fever, weight loss and/or lymphadenopathy lasting weeks of months. As the population grows older, a consequence of better and largely available treatments, the impact of non-AIDS-defining cancers (NADC) is having a greater impact on the management of HIV infected patients. Studies of different subtypes of HIV-1 in Romania show a very high prevalence of subtype F1, with values between 70% - 90% or the patients being infected with this strain. The study of HIV infected population in Romania is important for identifying particularities of the subtype F1 evolution. We conducted a prospective study on HIV positive patients under HAART treatment from the Constanta Regional Centre, for a period of eight years, between 2007-2015. All causes of new discovered cancers were recorded with the occasion of subsequent visits that are done on a regular basis. For comparison we used official data from of new diagnosed cancers from reports on health status for Constanta County for the same time period. The adjusted incidence ratio is 955.18/100000patient-years (95% CI 446.58 – 1463.75/100000 patient-years). As observed in similar studies conducted. HIV patients that undergo HAART treatment have an increased risk of all cancers significantly higher than what is observed in the general population. Considering this, better screening programs have to be developed and implemented for this population. Also, because of the suspicioned high number of HIV infected patients that are not diagnosed, a screening program for HIV should be implemented for all newly diagnosed patients with any type of malignancy.