Management Of HIV-positive Patients Research Articles

Adherence of health workers to guidelines for screening and management of cryptococcal meningitis in Uganda.

Health workers' failure to adhere to guidelines for screening, diagnosis and management of HIV-associated cryptococcal meningitis (CM) remains a significant public health concern. We aimed to assess adherence to the standards of care and management of HIV patients at risk of CM per the MoH guidelines and assess stock management of CM supplies in the period of January to June 2021 at selected public health facilities (HFs) in Uganda. The study employed an observational cross-sectional design to assess the level of adherence of health workers to standards of clinical care and management of HIV positive patients at risk of CM as per the clinical guidelines for Uganda, and stock management of CM supplies in the period of January to June 2021in selected public health facilities. The study team used a survey guide designed by MoH to assess and score the screening, diagnosis and management practices of Health Facilities towards CM. Scoring was categorized as red (< 80%), light green (80%-95%), and dark green (˃95%) in the order from worst to best adherence. The data was transcribed into a spread sheet and analysed using STATA-v15. The study team visited a total of 15 public health facilities including 5 general hospitals, 9 regional referral hospitals (RRHs) and 1 National Referral hospital (NRH). The mean score for adherence to screening and management of CM for all the combined facilities was 15 (64.7%) classified as red. 10 (66.7%) HFs had not performed a baseline CD4 test for eligible patients within 2 weeks of ART initiation. With regards to treatment, 9 (60%) of the HFs were scored as light green on knowledge of the procedure for reconstituting intravenous Liposomal Amphotericin B. None of the HFs visited had potassium chloride tablets in stock. Major MoH guidelines are generally not being adhered to by health workers while managing cryptococcal meningitis. It is vital that government and implementing partners regularly support HFs with training, mentorship, and support supervision on CM management to improve adherence to CM screening and treatment guidelines.

Hidradenitis Suppurativa in Patients with HIV: A Scoping Review.

Hidradenitis suppurativa (HS) is a chronic, debilitating skin disease of the apocrine glands. Bibliographic search revealed few studies concerning the association between HS and human immunodeficiency virus (HIV). To assess this link, we performed a systematic review of the current knowledge through a careful analysis of the relevant and authoritative medical literature in the field. Results showed that people with HIV are particularly susceptible to developing HS with the characteristic involvement of atypical sites, such as face or thighs, due to HIV-related immunosuppression. Based on the pathogenesis of both conditions and according to our review, we suggest that HIV screening should be routinely performed in suspected cases while monitoring and integrated approach in management are mandatory in the management of HIV-positive patients with HS.

Management of HIV positive patients by direct approach from dental service providers of Bangladesh

Management of HIV positive patients by direct approach from dental service providers of Bangladesh

Contribution of 18F-FDG PET/CT imaging in the diagnosis and management of HIV-positive patients

Introduction and objectivesThe human immunodeficiency virus [HIV] is a lentevirus, primarily infects certain cells of the immune system, thereby greatly weakens the body’s own defenses against diseases. This study was aimed to explore the value and significance of 18F-FDG PET/CT in the assessment of patients with HIV infection and to examine the presence of quantitative alterations in 18F-FDG uptake among patients with HIV-related infections or malignant diseases in HIV-positive patients. Patients and methodsForty patients with HIV infection were scanned on PET/CT system. The data were registered according to immune status, antiretroviral therapy, and definitive diagnosis. All pathologic lesions and disease related areas were described, 18F-FDG uptake patterns were evaluated. Semiquantitative analysis of 18F-FDG uptake was performed and SUVmax were calculated. ResultsTwenty-eight patients [70%] were diagnosed with HIV-related infection or malignant diseases. The sensitivity of PET/CT was shown to be 100% and the specificity 92% for concomitant diseases requiring additional treatment to antiretroviral therapy. The SUVmax and CD4 counts were not statistically different between HIV-related reactive lymphadenopathy, HIV-related malignancy, and HIV-related infections. ConclusionsThe pattern of distribution of nodal/extranodal uptake on 18F-FDG PET/CT may facilitate distinction between HIV-related generalized lymphadenopathies, HIV-related opportunistic infections, and malignancies. In this context, 18F-FDG PET/CT should be preferred for routine use in the management of patients infected with HIV.

Preoperative asymptomatic bacteriuria in patients undergoing total joint arthroplasty in South Africa

ABSTRACT BACKGROUND: Periprosthetic joint infections (PJIs) are a leading cause of revision for total hip arthroplasty (THA) and total knee arthroplasty (TKA), worldwide. Asymptomatic bacteriuria (ASB) is an independent risk factor for PJIs; however, a paucity of data relevant to developing countries exists. The aim of this study was to describe the prevalence of preoperative ASB and the subsequent incidence of PJIs in patients undergoing total joint arthroplasty (TJA) in South Africa. METHODS: We retrospectively reviewed primary THA and TKA patients. All patients were screened for ASB preoperatively. Patients with positive urinalysis for ASB were identified and treated prior to surgery (treated-ASB). The primary outcome was ASB prevalence and the incidence of PJIs and other perioperative complications. Secondary outcomes included risk factors for ASB and subsequent PJIs in treated-ASB patients, respectively, compared to those with no evidence of ASB (non-ASB). Lastly, we aimed to compare the infective microorganisms cultured from preoperative urinalysis and perioperative sampling of PJIs. RESULTS: We included 179 patients (67 THA; 80% female) with mean follow-up of 2.45 years. ASB prevalence was 22% (n = 39). Patients older than 70 years were 3.5 times more likely to have ASB compared to younger patients (p = 0.005). The prevalence of ASB was 22% (n = 10) for human immunodeficiency virus (HIV) positive and 22% (n = 29) for HIV-negative patients (p = 0.084). PJI incidence was 8% (n = 3) in the treated-ASB and 1% (n = 1) in non-ASB. Treated-ASB patients had an 11.6-fold increased likelihood of PJIs than non-ASB patients (p = 0.046). pJi microorganisms cultured did not correlate to isolates from urine cultures. CONCLUSION: The prevalence of ASB in a TJA population in South Africa is 22% which is higher than reported findings worldwide. Although the value of preoperative antibiotic therapy for ASB remains controversial, there is a role for routine urinalysis preoperatively to identify patients predisposed to PJI. This is of specific significance in the management of HIV-positive patients and in developing countries to guide healthcare providers in resource-constrained environments. Level of evidence: Level 2. Keywords: total hip arthroplasty, total knee arthroplasty, asymptomatic bacteriuria, periprosthetic joint infection, developing country

Re-organisation of the management of patients affected with chronic pathologies in Lombardy Region: critical points associated with the management of HIV positive patients.

SummaryThe Regional Council of Lombardy Region published in 2017 two resolutions related to a re-organisation of the management pathway of patients affected with chronic pathologies, to meet the changing needs of the users. The objective of this document is to provide recommendations to the Regional Health Service of Lombardy Region to manage the implementation of the resolutions considering peculiar aspects related to the management of HIV positive patients.These resolutions are a concrete answer to the changing needs of health care users within the regional context. The design of the new approach is coherent with the objectives stated, allowing a tighter integration between hospital services, primary care services and social services, however it should be adapted to each of the 62 chronic pathologies considered. In the case of HIV, not considering antiretroviral treatments within the tariff might limit the cost management capability of the case manager. The full implementation of the resolutions with the inclusion of social services will allow a complete management of chronic patients with positive consequences on their quality of life.

Safety and effectiveness of conventional systemic therapy and biological drugs in patients with moderate to severe psoriasis and HIV infection: a retrospective multicenter study

Background: The management of HIV-positive patients with psoriasis is controversial and limited to individual cases or short series of patients.Objectives: To evaluate the safety and effectiveness of conventional and biologic immunosuppressive drugs in the treatment of patients with psoriasis and concomitant HIV infection.Methods: A retrospective multicenter study was conducted. The study included data from 2008 to 2016. Inclusion criteria were: HIV adult patients with moderate-to-severe psoriasis, HIV viral load determinations at baseline and at least after 6 months of treatment, and systemic immunosuppressive treatment for at least 6 months. A descriptive analysis was performed.Results: Twenty-three patients with plaque-type psoriasis and HIV infection (five with AIDS) were included. Median follow-up time was 3.2 years. The main drugs used were etanercept, methotrexate, and ustekinumab. In most cases, viral load and CD4 cell count not only remained stable but also improved throughout the follow-up. Six patients presented severe adverse events during the follow-up, four of them in the AIDS stage. At the end of the follow-up period, 76.5% of the patients had achieved a PASI 75.Conclusion: Biologic drugs, both anti-TNF alpha agents and ustekinumab, seem to have an acceptable safety profile and high effectiveness in HIV-positive patients.

Point-of-care lung ultrasound for diagnosis of Pneumocystis jirovecii pneumonia: notes from the field

BackgroundThoracic ultrasound is helpful to evaluate lung pathology in patients with acute dyspnea. Several studies have demonstrated the efficacy of point-of-care ultrasound in patients with extrapulmonary TB and HIV co-infection. This retrospective, open-label case–control study explores the role of lung ultrasound in the diagnosis of Pneumocystis jirovecii pneumonia (PJP) in HIV-positive patients. In particular, it highlights the potential role of specific sonographic features that may be unique to this population.MethodsThe record of all HIV-positive patients admitted from 1.1.2013 to 31.6.2017 to the Department of Infectious Diseases and Tropical Medicine of san Bortolo Hospital, Vicenza, Italy, with a discharge diagnosis of acute lung injury (ALI) and who received point-of-care ultrasound of the chest for clinical purposes was included in the analysis. The patients were scanned according with the evidence-based recommendation.ResultsOf 273 HIV-positive patients whose records were reviewed, 81 (29.6%) were diagnosed with ALI. Complete documentation was available for 24 patients, of which 14 (58.3%) had microbiologically confirmed PJP (PJP+) and 10 (41.7%) had other conditions (PJP−). B-lines, subpleural consolidations, and cystic changes were significantly more frequent in patients with PJP (14/14 vs. 6/10, p = 0.0198; 14/14 vs. 4/10, p = 0.0016; 8/14 vs. 0/10, p = 0.0019, respectively). In particular, B-lines and subpleural consolidations were present in all PJP+ patients in our cohort giving a sensitivity of 100%, but their specificity was low (45 and 60%, respectively). On the contrary, the presence of consolidations with cystic changes had a very high specificity for PJP (100%), but low sensitivity (57%). Pleural effusions and consolidations with linear air bronchograms were not observed in PJP+ patients.ConclusionsB-lines, subpleural consolidations, and cystic changes are suggestive of PJP. Lung consolidation with air bronchograms and pleural effusion should prompt suspicion of other etiologies. These findings have the potential to be useful in the daily management of HIV-positive patients in resource-limited settings where other diagnostic tools are rarely available.

The clinical utility of the urine-based lateral flow lipoarabinomannan assay in HIV-infected adults in Myanmar: an observational study

BackgroundThe use of the point-of-care lateral flow lipoarabinomannan (LF-LAM) test may expedite tuberculosis (TB) diagnosis in HIV-positive patients. However, the test’s clinical utility is poorly defined outside sub-Saharan Africa.MethodsThe study enrolled consecutive HIV-positive adults at a tertiary referral hospital in Yangon, Myanmar. On enrolment, patients had a LF-LAM test performed according to the manufacturer’s instructions. Clinicians managing the patients were unaware of the LF-LAM result, which was correlated with the patient’s clinical course over the ensuing 6 months.ResultsThe study enrolled 54 inpatients and 463 outpatients between July 1 and December 31, 2015. On enrolment, the patients’ median (interquartile range) CD4 T-cell count was 270 (128–443) cells/mm3. The baseline LF-LAM test was positive in 201/517 (39%). TB was confirmed microbiologically during follow-up in 54/517 (10%), with rifampicin resistance present in 8/54 (15%). In the study’s resource-limited setting, extrapulmonary testing for TB was not possible, but after 6 months, 97/201 (48%) with a positive LF-LAM test on enrolment had neither died, required hospitalisation, received a TB diagnosis or received empirical anti-TB therapy, suggesting a high rate of false-positive results. Of the 97 false-positive tests, 89 (92%) were grade 1 positive, suggesting poor test specificity using this cut-off. Only 21/517 (4%) patients were inpatients with TB symptoms and a CD4 T-cell count of < 100 cells/mm3. Five (24%) of these 21 died, three of whom had a positive LF-LAM test on enrolment. However, all three received anti-TB therapy before death — two after diagnosis with Xpert MTB/RIF testing, while the other received empirical treatment. It is unlikely that knowledge of the baseline LF-LAM result would have averted any of the study’s other 11 deaths; eight had a negative test, and of the three patients with a positive test, two received anti-TB therapy before death, while one died from laboratory-confirmed cryptococcal meningitis. The test was no better than a simple, clinical history excluding TB during follow-up (negative predictive value (95% confidence interval): 94% (91–97) vs. 94% (91–96)).ConclusionsThe LF-LAM test had limited clinical utility in the management of HIV-positive patients in this Asian referral hospital setting.

Croatian Recommendations for Dialysis of HIV-Positive Patients

Abstract Human immunodeficiency virus (HIV) infection may be associated with renal impairment since about 0.4% of all HIV-positive patients develop end-stage renal disease. The share of patients with HIV infection in hemodialysis centers throughout the world ranges from 0.3% to as high as 38%. In Croatia, renal replacement therapy was needed by 1% of all the HIV-positive patients from 1985 until the end of 2014. Healthcare professionals (HP) should be aware of the risks of occupational exposure to blood-borne infections in their daily work. Performing dialysis in HIV-positive patients increases the risk of exposure to HIV during the extracorporeal circulation of the infected blood. However, post-exposure prophylaxis (PEP) with effective antiretroviral drugs significantly reduces the risk of infection after occupational exposure. On behalf of the Croatian Society of Nephrology, Dialysis and Transplantation, the authors of this paper have proposed recommendations for the management of HIVpositive patients on dialysis, which aim to prevent the transmission of HIV among patients and HPs. The important recommendations include the following: 1. when the need arises, it is necessary to provide HIV-positive patients with dialysis in the vicinity of their place of residence. 2. HIV-positive patients should be dialyzed with a separate hemodialysis machine in an isolated area. Alternatively, they can be dialyzed in an area for the hemodialysis of HCV-positive and/or HBVpositive patients. 3. Specialized and trained personnel should be provided during the hemodialysis procedure, together with strict compliance with the standard precautions for the prevention of blood-borne infections. 4. There should be a good and prompt cooperation with the National Referral Center for HIV infection.

Role of cranial computed tomography in human immunodeficiency virus-positive patients with generalised seizures

Background: Emergency neuroimaging of human immunodeficiency virus (HIV)-positive patients with generalised new onset seizures (NOS) and a normal post-ictal neurological examination remains controversial, with the general impression being that emergency imaging is necessary because immunosuppression may blur clinical indicators of acute intracranial pathology. The objectives of our study were to establish whether cranial computed tomography (CT) affects the emergency management of HIV-positive patients with generalised NOS and a normal post-ictal neurological examination.Method: We conducted a prospective descriptive observational study. Consecutive HIVpositive patients of 18 years and older, who presented to the Kimberley Hospital Complex’s Emergency Department within 24 hours of their first generalised seizures and who had undergone normal post-ictal neurological examinations, were included. Emergency CT results as well as CD4-count levels were evaluated.Results: A total of 25 HIV-positive patients were included in the study. The results of cranial CT brought about a change in emergency care management in 12% of patients, all of them with CD4 counts below 200 cells/mm3 .Conclusion: We suggest that emergency cranial CT be performed on all HIV-positive patients presenting with generalised NOS and a normal post-ictal neurological examination, particularly if the CD4 count is below 200 cells/mm3.Keywords: HIV; Seizures; CT Brain

P137 Is the management of HIV positive lymphoma patients within small cohort centres in line with current best practice guidelines?

Background As the incidence of opportunistic infections accounting for HIV-related deaths has declined significantly, malignancies now account for approximately a third of HIV related death with the majority of these being lymphoma related. Aims To determine whether management of HIV positive patients within small centres is in line with current best practice guidelines. Methods All HIV positive patients diagnosed with lymphoma or relapsing with lymphoma, from 2010 to 2015, in the BASHH Wessex region were eligible for inclusion. On review of previous studies and current BHIVA guidelines, a data collection tool was designed to accumulate relevant patient information to review care. Data collection was conducted at three centres across Wessex. Results The total sample size of the study was 25 patients, all of which received the recommended diagnostic and staging procedures. Of the patients with documented staging, 73% were diagnosed with stage 4 lymphoma and 50% had an International Prognostic Index score of 3 or more. The mean follow up time of each patient was 19 months (from 1 to 64 months). Within the follow up time, the overall survival rate was 72%. In those followed up for a minimum of 2 years, the progression free survival rate was 100%. Conclusions Although the small sample size does not allow comparison with larger cohorts, current findings suggest that management of HIV positive lymphoma patients within these smaller centres is in line with best care guidelines. The formation of a national registry would allow for closer monitoring of this in the future.

Optimal management of cervical cancer in HIV-positive patients: a systematic review.

The clinical management of cervical cancer in HIV-positive patients has challenges mainly due to the concerns on immune status. At present, their mode of management is similar to HIV-seronegative patients involving the use of chemotherapy and radiotherapy concurrently as indicated. HIV infection, cancer, radiotherapy, and chemotherapy lower immunity through reduction in CD4 cell counts. At present there are no treatment guidelines for HIV-positive patients. This study was done to systematically review the literature on cervical cancer management in HIV-positive patients and treatment outcomes. A systematic literature search was done in the major databases to identify studies on the management of HIV-positive patients with cervical cancer. Identified studies were assessed for eligibility and inclusion in the review following the guidelines of The Cochrane Handbook for Systematic Reviews and CRD's (Centre for Reviews and Dissemination) guidance for undertaking reviews in health care. Eight eligible studies were identified from the literature. Three of them were prospective while five were retrospective studies. Notably, the average age at diagnosis of cervical cancer in HIV-positive patients was a decade lower than in seronegative patients. There was no difference in distribution of stages of disease at presentation between HIV-positive and negative patients. Mild acute toxicity (Grades 1 and 2) was higher in HIV-positive patients than in HIV-negative patients in hematopoietic system. In the grades 3 and 4 reactions, anemia was reported in 4% versus 2% while gastrointestinal reactions were reported in 5% versus 2% respectively. In general, patients who were started early on HAART had higher rates of treatment completion. The study supports the suggestion that HAART should be commenced early at cervical cancer diagnosis in HIV-positive patients diagnosed with cervical cancer to ensure less toxicity and better treatment compliance.

Validity and Reliability of Total Lymphocyte Count as Alternative Biomarker for CD4 Count in the Management of HIV Positive Patients on HAART in Osogbo, Nigeria

Introduction: To determine the possibility of utilizing total lymphocyte counts (TLC) instead of CD4 counts in the initiation and management of patients with HIV on highly active antiretroviral therapy (HAART). The commencement of HAART CD4 lymphocytes has been employed in the management HIV. However it has been found that determination of CD4 counts is expensive and somewhat laborious to perform in already overburdened healthcare systems especially in the developing countries. Methodology: Five hundred and three (503) consenting patients already on HAART (commenced at CD4 count < 350 cells/μl) who attended our HIV clinic between February 2014 and February 2015 were enrolled into the study. The patients had already been diagnosed as HIV positive. Kappa statistic was computed as a measure of reliability of TLC. Various cut-off marks for TLC in respect of the CD4 counts were determined in addition to the computation of both sensitivity and specificity. Receiver operating curves (ROC), showing area under the curve indicating agreement in classification, were plotted. Results: Majority of patients were female (73.8%). Most of the patients were in the age range of 25 - 34 years (37.2%). Males were found to be significantly older than females (P < 0.05). Area under the receiver operating curves (ROC) revealed that 4 out of 10 patients would be missed using total lymphocyte count (TLC) as the indicator for commencement of HAART. A low correlation coefficient and Kappa statistic r = 0.18, and K = 0.20 respectively, were observed between TLCs and CD4 counts. Conclusion: Total lymphocyte count is not a suitable alternative to CD4 counts in the management of HIV/AIDS.

Human immunodeficiency virus associated tuberculous lymphadenitis: a clinical study of 50 cases of Saurastra region of Gujarat, India

Background: Tuberculosis continues to be one of the most important public health problems worldwide. HIV-TB co-infection contributes greatly to morbidity & mortality in patients. The objective of the study was to study clinical profile of tuberculous lymphadenitis in HIV positive patients. Methods: The present study was conducted in the Department of Tuberculosis and Chest Diseases, P.D.U. Medical College and Hospital, Rajkot during June 2011 to August 2012. Total 50 indoor HIV positive patients clinically suspected of having tuberculous lymphadenitis were included by purposive sampling method. Information regarding past and family history were collected after taking written consent using pre designed, pretested semi structured Performa. Patient were examined and evaluated by necessary investigation. Data was statistically analysed using SPSS software (trial version). Results: Out of total 50 patients, 42 (84%) patients were male. Age range of patients was 11 to 70 years with mean age was 34.8 ±10.3 years. All 50 patients presented with painless swelling. 11 (22%) patients had past history and 3 (6%) had family history of tuberculosis. 47 (94%) patients had cervical lymphadenopathy. 5 (10%) had sputum positive pulmonary tuberculosis. 21 (42%) patients were already on anti-retro viral therapy (ART). 23 (46%) patients had epithelioid granuloma with necrosis followed by 18 (36%) patients had epithelioid granuloma without necrosis revealed by FNAC. Half of the patients had abnormal chest radiograph with infiltration and pleural effusion in 14% and 10% respectively. Conclusions: Cervical and axillary lymphadenopathy was most common involved site in tuberculous lymphadenitis in HIV positive patients. FNAC is a relatively inexpensive initial investigative technique in the diagnosis and management of HIV-positive patients.

Медико-социальная характеристика ВИЧ-позитивных пациентов с опийной зависимостью

В статье приведены результаты изучения медико-социальной характеристики ВИЧ-позитивных пациентов с опийной зависимостью. Выявлены основные социальные и медицинские проблемы наркозависимых пациентов c ВИЧ-инфекцией. При формировании тактики ведения ВИЧ-позитивных пациентов с опийной зависимостью необходимо учитывать особенности социального функционирования, наркологического и соматического анамнеза, которые могут влиять на течение коморбидной патологии и ее исход.

Impact of antiretroviral medications on fasting lipid parameters.

It is widely accepted that metabolic disease in human immunodeficiency virus (HIV) develops at the intersection of traditional risk factors and HIV-specific contributors, but in observational studies it is difficult to dissect the contribution of the two. This review describes the metabolic impact of antiretroviral medications recommended in the first-line treatment in HIV-infected naive patients. At a clinical level, coronary heart disease screening and management will continue to be of paramount importance in the long-term management of HIV-positive patients on antiretroviral therapy.

Physiologically Based Pharmacokinetic Models for the Optimization of Antiretroviral Therapy: Recent Progress and Future Perspective

Anti-HIV therapy is characterized by the chronic administration of antiretrovirals (ARVs), and consequently, several problems can arise during the management of HIV-positive patients. ARV disposition can be simulated by combining system data describing a population of patients and in vitro drug data through physiologically based pharmacokinetic (PBPK) models, which mathematically describe absorption, distribution, metabolism and elimination. PBPK modeling can find application in the investigation of clinically relevant scenarios, while providing the opportunity for a better understanding of the mechanisms regulating drug distribution. In this review, we have analyzed the most recent applications of PBPK models for ARVs and highlighted some of the most interesting areas of use, such as drug–drug interaction, pharmacogenetics, factors regulating absorption and tissue penetration, as well as therapy optimization in special populations. The application of the PBPK modeling approach might not be limited to the investigation of hypothetical clinical issues, but could be used to inform future prospective clinical trials.

Detention and incompatibility of HIV patients in Italy. .

In Italy, Law 231/99 and subsequent amendments standardize the conditions allowing or not a HIV positive inmate to remain in jail. Currently such clinical conditions are not automatically associated with the decline of preventive detention and the Court evaluates the incompatibility with detention on the basis of two additional and independent criteria. We have been observing the tendency by jailed HIV-positive patients to manipulate the disease state believing that the rules of incompatibility with the prison system are always applied. The management of HIV positive patients in jail involves significant sanitary and relational efforts, particularly for those suffering AIDS and/or with severe immunodeficiency.

British HIV Association guidelines for the management ofHIVinfection in pregnant women 2012

British HIV Association guidelines for the management of<scp>HIV</scp>infection in pregnant women 2012