Manifestations Of AIDS Research Articles

Multilocular subcutaneous bacillary angiomatosis as a primary manifestation of AIDS

AbstractA 34‐year‐old male patient presented with a clinical picture of multilocular subcutaneous skin nodules in addition to marked lymphadenopathy and general physical deterioration. A comprehensive diagnostic workup including serology, skin biopsy and imaging studies led to the initial diagnosis of human immunodeficiency virus (HIV) infection in AIDS stage with rare multilocular subcutaneous bacillary angiomatosis (BA) caused by Bartonella henselae. BA describes a process of neovascularisation of the skin or of internal organs (particularly the liver and spleen) and was first described in HIV‐positive patients by Stoler et al. in 1983. Both cutaneous and systemic symptoms are variable. There is no standardized treatment. The patient was started on antibiotic therapy with doxycycline, which was subsequently augmented with rifampicin. As the patient's general condition deteriorated and lymphocytopenia aggravated, he was transferred to an internal medicine ward for further treatment and subsequently commenced on antiretroviral therapy. This case corroborates numerous aspects of the cases described in the literature yet differs from them in that subcutaneous lesions are uncommon, particularly when infected with Bartonella henselae, illustrating the clinical spectrum of BA. Furthermore, it emphasises the significance of prompt and thorough diagnosis encompassing HIV serology in instances of skin lesions, accompanied by systemic signs and evidence of immunosuppression.

Zidovudine, a brief history before the first antirretroviral in Mexico.

In the 1980s in Mexico, that of the «moral renewal», there was the opening to the market and the manifestation of human immunodeficiency virus (HIV) and AIDS. In this writing, the historical and therapeutic conditions are related to alleviate the syndrome until the arrival of the first antiretroviral. It is a reconstruction of the events, of which the medical-social, main clinical manifestations and of course the pharmacological therapy, until de the development zidovudina or azidotimidina of AZT, the first antiretroviral to be approved. Nevertheless, in the Mexican context, this event wasn't decisive to significantly change the morbility and the mortality.

Imaging findings of acute calcific periarthritis, with emphasis on magnetic resonance imaging: pictorial essay.

Acute calcific periarthritis (ACP) is defined as periarticular inflammation associated with intra-articular deposits of hydroxyapatite and other basic calcium phosphate crystals. Patients with ACP present with a sudden onset of pain, together with localized swelling, as well as erythema, tenderness, and reduced range of motion. Familiarity with the clinical and radiological manifestations of ACP aids in the diagnosis and helps differentiate it from other conditions, particularly infectious or inflammatory pathologies such as septic arthritis and gout, thereby reducing the number of unnecessary diagnostic and therapeutic procedures. The objective of this pictorial essay is to illustrate the imaging findings of ACP in various joints, with an emphasis on the findings obtained by magnetic resonance imaging.

Investigating bothersome lower urinary tract symptoms among people living with HIV on antiretroviral therapy: prevalence, influencing factors, and quality-of-life implications

BackgroundUrological complications are not uncommon among people living with HIV and are often the initial clinical manifestation of HIV and AIDS. These complications, when presenting with bothersome lower urinary tract symptoms (LUTS), can significantly impact the Quality of life (QoL) of affected individuals. We, therefore, conducted a study aiming at determining the prevalence of bothersome LUTS, identifying factors influencing the severity of these symptoms, and examining their influence on the QoL among people living with HIV on antiretroviral treatment (ART).MethodsA cross-sectional study was conducted among randomly selected adult HIV-positive patients who attended the Care and Treatment Center at Muhimbili National Hospital, located in Dar es Salaam, Tanzania, from September 2021 to February 2022. Data was collected using a questionnaire that incorporated the American version of the International Prostate Symptom Score (IPSS). The IPSS was utilized to assess the severity of LUTS and their influence on the QoL. Descriptive statistics were used to summarize the results, and ordinal regression analysis was employed to assess the factors influencing the severity of LUTS.ResultsThe prevalence of LUTS in the study population was 57.8%, with mild symptoms (mean IPSS 3.92 ± 1.92) being the most common manifestation. The mean age of the study participants who presented with LUTS was 47.89 ± 12.05 years, and the majority were females (55.6%). Factors that were significantly associated with increased severity of LUTS included male sex (OR 2.75; 95% CI 1.59–4.75; p < 0.001), age above 49 years (OR 3.02; 95% CI 1.49–6.16; p = 0.002), ART use for over 10 years (OR 3.03; 95% CI 0.9–6.10; p = 0.021), and HIV stage IV (OR 2.42; 95% CI 0.9–3.4; p = 0.047). The majority of the study participants reported an above-average QoL, with only 9.7% of them reporting unhappy-terrible experiences with urinary symptoms. However, a statistically significant (p < 0.001) inverse correlation between QoL and the severity of LUTS was observed.ConclusionsIn light of these findings, policymakers and healthcare providers should integrate routine assessment and management of LUTS into the care protocols tailored for these high-risk groups. This proactive approach holds the potential to enhance the QoL and overall welfare of people living with HIV.

CEREBRAL TOXOPLASMOSIS IN THE COURSE OF HIV INFECTION - CASE STUDY.

Aim: To the aim of our study is to draw attention to the need to take into account HIV infection and its complications, such as CNS toxoplasmosis, in the differential diagnosis of people presenting with impaired consciousness. We analyzed our patient's medical records and available statistical data on HIV infection, as well as literature on nervous system involvement in the course of AIDS. Materials and Methods: In our paper, we present the case of a 43-year-old male who was admitted to a neurological ward due to impaired consciousness. Diagnostic imaging and laboratory tests were conducted, and patient was diagnosed with toxoplasmosis in the course of AIDS. Conclusions: HIV infection is a global public health problem. In the absence or ineffectiveness of treatment, it leads to profound immunodeficiency and, consequently, opportunistic infections. One of them is the reactivation of the latent Toxoplasma gondii infection. It is the most common cause of extensive cerebral lesions in patients infected with the HIV virus. In these cases, MRI reveals numerous scattered ring-enhancing lesions. The symptoms are non-specific: headaches, impaired consciousness, convulsions, behavioral changes, and focal neurological deficits. The onset of neurological symptoms may be the first clinically relevant manifestation of AIDS. It is key to diagnose such patients as soon as possible and treat them accordingly.

MANIFESTASI ORAL TERKAIT IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME PADA HUMAN IMMUNODEFICIENCY VIRUS/ ACQUIRED IMMUNODEFICIENCY SYNDROME

Introduction: Treatment for Human Immunodeficiency Virus (HIV) infections using antiretroviral (ARV) resulting in varying stage response in the oral cavity. Some studies showed good responses but can also lead to Immune Reconstitution Inflammatory Syndrome (IRIS). IRIS is widely known as a complication of ARV therapy. Oral lesions in HIV / AIDS patients that emerge after taking ARV therapy can be categorized as IRIS cases. This systemic review aims to observe oral manifestations associated with IRIS. Review: Systematic review is carried out by the PRISMA method. The inclusion criteria are clinical trial articles collected from electronic searches, including full text through the PubMed portal, Research Gate, and Google Scholar using keywords: HIV / AIDS, IRIS, and oral manifestations which were published from 2011 to December 2019. A total of 6 articles were identified. The results showed that oral lesions in HIV/ AIDS related to IRIS are Kaposi Sarcoma 29.2%, OHL 16.9%, oral candidiasis 11.5%, and RAS 5.6%. The incidence of IRIS was around 10-27% in HIV / AIDS patients who have started ARV therapy. The incidence of IRIS is higher in prevalence in patients starting ARV therapy with low CD4 counts. Conclusion: Oral manifestations associated with IRIS in most HIV /AIDS patients are Kaposi's Sarcoma, OHL, Oral candidiasis, and SAR

Prevalence of Oral Lesions among HIV Positive Patients Attending Antiretroviral Therapy Centre in Rural Area of Western Maharashtra

Introduction: The Oral Manifestations (OM) of Human Immunodeficiency Virus (HIV) is indication of compromised immune status and disease progression. These Oral Lesions (OL) cause morbidity and affect quality of life of the patients. Aim: To evaluate the association between OM in patients with HIV infection and their level of cluster of differentiation 4 (CD4) count. Materials and Methods: The study was designed as a descriptive, cross-sectional study for a duration of two years which included a total of 565 known HIV-positive individuals visiting the regional Antiretroviral Therapy (ART) center for counseling and/or on Highly Active Antiretroviral Therapy (HAART) were selected irrespective of age and sex. The oral lesions were diagnosed using the presumptive criteria given by by the European Committee (EC) Clearinghouse, 1993. Oral and systemic manifestations were recorded and associated with CD4 counts. The data collected was subjected to statistical analysis using Statistical Package of Social Science (SPSS) 8.0 software and p-value was considered significant at a level of 0.05. Results: The male-to-female ratio was almost equal and 95.04% of the patients had reported heterosexual contact as the transmission route. The peak age of occurrence of HIV infection was during 31-40 years with the mean age of males and females 39.26 years and 34.46 years respectively. Pulmonary tuberculosis (16.11%) and herpes zoster (16.81%) were the most common systemic manifestations. The prevalence of OM reported was 86.01% and was higher in females than in males. Intraoral melanotic pigmentation (50.08%) was the most common finding, followed by periodontitis (36.46%), linear gingival erythema (14.51%), Necrotising ulcerative gingivitis (NUG) (4.42%), candidiasis (8.67%), oral ulcers, herpes zoster (5.13%), herpes simplex virus infection (1.17%) and salivary gland disease (SGD) (0.7%). There was a significant association (p=0.0110) between OL and reduced CD4 count. Conclusion: OL occur commonly in HIV infection. The decrease in CD4 count is associated with a wide range of OM. The result from this study can be used as predictive marker for oral manifestations in AIDS based on the level of immune suppression and help in improving their quality of life.

Extensive progressive multifocal leukoencephalopathy as the first manifestation of AIDS.

Extensive progressive multifocal leukoencephalopathy as the first manifestation of AIDS.

Autoantibodies to 21-hydroxylase as a diagnostic marker of primary autoimmune adrenal insufficiency, including at its potential and latent stages

Rationale: In Russia, assessment of anti-P450c21 antibodies (AB) in the diagnosis of autoimmune adrenal insufficiency (AAI) has not been commonly used, and the disease screening has not been implemented.Aims: 1) To determine the sensitivity and specificity of anti-P450c21 AB determination in the AAI diagnosis; 2) To estimate the prevalence of anti-P450c21 AB carriage in patients without AAI.Materials and methods: Anti-P450c21 AB were assessed in 40 patients (group 1) with manifest AAI; 171 patients without established diagnosis of AAI, including 113 subjects with autoimmune thyroid disorders or type 1 diabetes mellitus (AID, group 2); 25 carriers of AB markers of thyroid AID and/or type 1 diabetes mellitus without any target organ dysfunctions (group 3); 33 patients with non-autoimmune endocrine disorders (group 4), and 25 healthy individuals (group 5).Results: Determination of anti-P450c21 AB for the diagnosis of AAI had 95% sensitivity, with specificity of 100%, predictive value of a positive result of 100%, and predictive value of a negative result 92.6%. Anti-P450c21 AB were inversely correlated with the duration of glucocorticoid replacement therapy (r=-0.222, p&lt;0.05). High levels of anti-P450c21 AB were found in 4 (3.5%) patients of group 2; based on the results of additional hormonal testing, 50% cases were diagnosed with the latent stage of the disease and 50% cases with the potential stage.Discussion: The sensitivity of the anti-P450c21 AB determination for AAI diagnosis in our study was higher, than in the works by other authors. We have confirmed a time-related reduction of anti-P450c21 AB levels, whereby the strength of the correlation was higher in the subgroups with autoimmune polyendocrine syndrome type II and, to a greater extent, autoimmune polyendocrine syndrome type I. This might be related to their different pathogenesis, with an abnormality of central immune tolerance in autoimmune polyendocrine syndrome type I and that of peripheral immune tolerance in autoimmune polyendocrine syndrome type II. According to our data, in 50% of cases, the development of AAI was preceded by the manifestation of other AIDs (in 15% of cases being multiple). Among all patients with no AAI diagnosis at the study entry, increased anti-P450c21 AB levels were found exactly in those with pre-existing AID. Thus, we have confirmed the feasibility of AAI screening primarily in a cohort of patients with other AID (especially multiple) belonging to the risk group.Conclusion: The determination of blood anti-P450c21 AB is a highly sensitive and highly specific method to diagnose AAI. The frequency of anti-P450c21 AB detection might depend on the duration of glucocorticoid treatment. Screening for early AAI stages is relevant primarily in the risk groups with multiple autoimmune disorders.

Prevalence of nail changes in patients infected with HIV - A cross sectional study

Introduction: The spectrum of nail changes is wider and their frequency is higher among HIV patients. These changes magnify the range and multiplicity of AIDS manifestations. Their systematic examination is a non-invasive method of possible diagnostic value . Objective: The present study was conducted to study the frequency and types of nail changes in &nbsp; HIV infected individuals and to correlate the severity of nail changes &nbsp; with CD4 count. Material and Method: This was a cross sectional study, conducted in Skin &amp; STD Out-Patient department in a tertiary care hospital between March 2018 and April 2019. A total of 176 HIV patients were included in the study. Standardized examination was performed in which the changes in surface, color, thickness and curvature of nail plates were recorded. &nbsp; Data were coded and analyzed. Results: The prevalence of nail changes in our study was 60.8%. Majority of the patients were in the age group of 34-41 years(38.1%) with a slight female preponderance Absent lunula (33.5%), diffuse pigmentation of nails (29.54%) and nail dystrophy (18.2%) occupied the top three changes followed by longitudinal melanonychia (13.06%), flat nails (4%), onychomycosis (3.4%) and pterygium (2.8%). Majority of the patients who had abnormal nails had CD4 count in the range of more than 500 cells/mm 3 (30.68%) because many patients in our study were having CD4 count more than 500 cells/mm 3 . The strength of association between abnormal nail changes and CD4 count was done by Chisquare test and the p value was 0.575 which was not &nbsp; statistically significant. Conclusion: This study infers that systematic nail examination of HIV patients is necessary, but their relation to the severity of immunosuppression requires further large scale, multicentric studies. Key words: CD4 count, HIV/AIDS, Nail changes, Anolunula

Organizing Pneumonia as a Manifestation of AIDS in a Patient With Partially Treated Pneumocystis Jiroveci Pneumonia

Abstract Organizing pneumonia (OP), formerly called bronchiolitis obliterans organizing pneumonia, is a rare disease characterized by necrotizing granulomas and fibrosis in the small airways of lungs. We arguably present the fourth reported case of a patient with human immunodeficiency virus who was diagnosed with OP in the setting of partially treated Pneumocystis jiroveci pneumonia (PJP). A 59-year-old white man with human immunodeficiency virus and acquired immunodeficiency syndrome had multiple admissions for pneumonia, which was culture negative and partially treated for possible PJP. Eventually, a lung biopsy showed necrotizing OP and fibrosis, typical of OP, with granulomatous features and 3 PJP organisms seen on biopsy. The patient eventually improved with intravenous corticosteroids, whereas primaquine and clindamycin were continued for partially treated PJP. Organizing pneumonia should be considered in immunodeficiency with persistent pulmonary infiltrates not responding to antibiotic therapy. Whether immunodeficiency or infections predispose these patients to OP remains unclear. Prolonged corticosteroids remain the cornerstone of therapy in OP.

Progressive Multifocal Leukoencephalopathy as the First Manifestation of AIDS: A Rare Case Report

Introduction: Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system (CNS) caused by the JC virus (JCV). Case Presentation: A 47-year-old woman with no history of any underlying diseases was hospitalized at our center with a loss of consciousness and aphasia. The investigation of the patient’s history revealed that she had been hospitalized in another hospital a month earlier due to right hemiparesis and dysarthria. Brain imaging was repeated that revealed demyelinating lesions. The laboratory studies showed a positive human immunodeficiency virus (HIV) serology. The polymerase chain reaction (PCR) of the cerebrospinal fluid (CSF) for JCV turned out positive and the diagnosis of PML was established. Conclusions: Progressive multifocal leukoencephalopathy should always be considered as an important differential diagnosis in patients with demyelinating brain lesions and HIV testing should be considered in these patients, as well.

Evaluation of oral care protocols practice by dentists in Rio de Janeiro towards HIV/AIDS individuals

BackgroundThe aim of this study was to evaluate the dentists’ knowledge and practice regarding HIV positive individuals’ oral care in Rio de Janeiro State.MethodsDentists from Rio de Janeiro State (n = 242) answered an electronic questionnaire on biosafety procedures, oral manifestations of AIDS, and knowledge of HIV infection. Collected information was stratified by gender, and data were analyzed using Chi-square and t tests.ResultsFrom the 14 oral manifestations investigated, oral candidiasis, necrotizing ulcerative gingivitis, and hairy leucoplakia were more associated with HIV, with no differences between the responses from men and women. Above 85% of the participants would be concerned about becoming infected with HIV after a needle/ sharp object injury and more than 80% of them were willing to be tested for HIV. However, significantly more women (98.8%), compared to men (91.3%), said they knew that HIV/ AIDS patients can contaminate dental care professionals, p = 0.007. There was a significant difference in the answers for the questions: “Are there special dental clinics for treatment of HIV/AIDS patients in Brazil?” (p = 0.044), and “Do the negative HIV tests surely indicate that the persons are free of viruses?” (p = 0.005). Significant differences between men and women were also observed regarding use of disposable mask (p = 0.01), and cap (p < 0.0001).ConclusionMost dentists who participated in the study presented a good knowledge on the care of HIV/ AIDS individuals, including biosafety protocols and in terms of the oral manifestations commonly associated to AIDS.

A rare case of progressive multifocal leukoencephalopathy – As a presenting manifestation of AIDS

Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating central nervous system (CNS) infection disease that exclusively affects immunocompromised individuals. John Cunningham virus, the etiologic agent for PML, is ubiquitous in the general population but rarely causes disease in immunocompetent hosts. Here, we present a 35-year-old male with left hemiparesis and loss of vision, diagnosed as PML as the first AIDS-defining event, with previously undiagnosed human immunodeficiency virus (HIV) infection. PML is an underinvestigated CNS infection seen in HIV patients usually with advanced disease. We present an unusual case report, where PML occurred as the first AIDS-defining event in a patient with previously undiagnosed HIV infection. This case is presented to enlighten the physicians regarding the clinical entity of PML to be suspected in HIV-infected patients who present with focal neurologic deficits even in undiagnosed infection.

ETIOPATHOGENIC, EPIDEMIOLOGIC AND CLINICAL-THERAPEUTIC COMPARISON OF NON-HODGKIN'S LYMPHOMA AND KAPOSI'S SARCOMA.

ABSTRACT Background: Non-Hodgkin’s lymphomas (NHL) are primary neoplasms derived from lymphocytes, and Kaposi’s sarcoma (SK) is a multicentric disease of viral etiology and is associated with HIV. Aim: To study the etiopathogenesis and clinical characteristics of NHL and KS, describing their mutual factors. Methods: This retrospective investigation was performed on 101 medical charts. The patients were studied according to their age, gender, and HIV-positivity, following the PRISMA guidelines. The characteristics of the tumors and comorbidities were analyzed according to their age and lymphatic metastasis. Results: The mean age of the patients ranged between 15-87 years for NHL and between 25-54 for KS, but the age of patients with NHL associated with HIV did not surpass 34 years. The ratio male: female was 1,8:1 for NHL, but only men presented KS. HIV-positivity was found in five patients with NHL and in 14 with KS. The stages of NHL were: I (21%), II (18,4%), III (26,3%), and IV (34,2%), but KS were found only at III (40%) and IV (60%) stages. The lymphatic metastases were positive in 62 patients NHL and in four with KS. HIV-positivity occurred in 60% of patients with NHL and in 50% with KS. Conclusion: The HIV seropositivity was revealed for most of patients during the NHL and SK propaedeutic and none of them present clinical manifestations of AIDS. NHL associated with HIV was found only in young patients. NHL and KS patients have similar epidemiological, clinical, and therapeutic characteristics.

An overview on the epidemiology of aids and its related seizure in Iranian society

Seizures are a frequent manifestation of central nervous system disorders in patients infected with HIV. In the present study, the aim of the study was to determine the prevalence of seizure among AIDS patients in Iran. In this cross-sectional study, patients who were diagnosed with HIV infection admitted to Rasoul-e-Akram Hospital between 2011 and 2016 were assessed. All study information was extracted from the hospital recorded files. In this study, 443 patients with HIV infection. In terms of sex distribution, 325 cases (73.3%) were men and 118 cases (26.7%) were women. Of the 443 patients, only 4 patients (3 cases of male and 1 female) had a history of seizure during the course of the disease, indicating a 0.9% prevalence of seizure and epilepsy among HIV patients. Seizure was more prevalent as a neurological manifestation of AIDS in the second and third decades of life. Patients suffering seizure had significantly lower CD4 count. There was no relationship between seizure incidence and hepatitis B and C infection. The seizure was controlled with Levetiracetam or sodium valproate regimens. The occurrence of seizure in HIV patients has an etiologic relationship with toxoplasmosis as well as with cytomegalovirus infections leading to encephalitis. The prevalence of seizure in AIDS patients in our community is estimated to be 0.9%, which is prevalent in men and in the second and third decades of life. Patients who suffer seizure display lower CD4 positive counts indicating seizure occurrence in the end stages of the disease.

Inopportune Opportunism: First Diagnosis of AIDS in New-Onset Viral Myocarditis

Opportunistic infections from cytomegalovirus (CMV) are a possible manifestation of late-stage AIDS. We present a case of acute CMV myocarditis, which eventually allowed for the diagnosis of a previously unknown HIV infection.

Systemic Manifestations in Aids – Prospective Study in GGH Nalgonda

Systemic Manifestations in Aids – Prospective Study in GGH Nalgonda

Evaluation of dental students' knowledge and patient care towards HIV/AIDS individuals.

The aim was to evaluate the knowledge of the students of dental students regarding patients care towards HIV positive individuals. Two hundred and eighty-three dental students (pre-clinical, n=45; clinical, n=238) answered an electronic questionnaire, approaching biosafety procedures, oral manifestations of AIDS and knowledge of HIV infection. Data were present as an average from findings from students of nine different semesters, grouping them by pre-clinical (1-4) and clinical (5-9) semesters, from two different university campuses. Furthermore, data were analysed using the t test and chi-square test. Students' mean age was 24years. Amongst 14 oral manifestations questioned, Kaposi sarcoma, oral candidiasis, necrotizing ulcerative gingivitis and herpes simplex were more associated with HIV. Over 90% of the respondents would be concerned about becoming infected with HIV after a needle stick injury and were willing to be tested for HIV; know that HIV/AIDS patients can contaminate dental care professionals, that needle perforation can transmit HIV, and that medical professionals are more prone to cross-contamination. Regarding the use of physical barrier, almost all participants use disposable mask, goggles, cap and procedure gloves with all patients; the use of disposable lab coat and two pairs of gloves were the least used with all patients. Participating students have good knowledge on biosafety in the management of HIV/AIDS patients, as well as on the most commonly associated oral manifestations. However, there is a need for improvement on some topics related to HIV/AIDS, especially regarding less known oral lesions, and HIV diagnostic tests.

English

Hepatobiliary diseases occur commonly in patients with Human immunodeficiency virus (HIV) infection and are now the commonest cause of death in HIV positive patients on antiretroviral therapy (ART) in western countries. The hepatobiliary manifestations of AIDS are related to the levels of CD4+ count as well as liver enzymes. Abdominal ultrasound examination is easy to perform, non-invasive, inexpensive, readily available and provides valuable information about hepatobiliary findings in AIDS. The study was to evaluate hepatobiliary sonographic findings in HIV/AIDS adult patients and correlate with their CD4+ count and abnormal liver enzymes (ALP, ALT and AST) in Jos, Plateau State, Nigeria. A cross-sectional study of hepatobiliary ultrasound findings of 410 adult patients with HIV/AIDS was carried out over a period of six months. Two hundred and sixteen (52.7%) of the patients had normal hepatobiliary ultrasound findings while 194 (47.3%) patients had various abnormalities. The common abnormalities seen include enlarged gallbladder in 33.5%, increased liver parenchymal echogenicity in 26.3%, hepatomegaly in 23.7%, and thickened gallbladder wall in 7.8% patients. Other findings included gallbladder sludge and gall stone in 6.6 and 2.1% respectively. These findings correlated significantly with the patients’ CD4+ count and liver enzymes (ALT, AST and ALP) with p value < 0.05 in both. Ultrasonography as a baseline imaging modality in HIV/AIDS patients, together with CD4+ count and liver enzymes are useful in the assessment of the disease state, monitoring of therapy and management of these patients. Key words: Hepatobiliary ultrasonography, adult patients, CD4 cell count, HIV/AIDS, liver enzymes.