Manifestations Of Human Immunodeficiency Virus Research Articles

A young male patient with cardiomyopathy associated with human immunodeficiency virus infection in the era of highly active antiretroviral therapy

Background: Cardiomyopathy in young people, especially those associated with HIV infection, has been reduced since the era of Highly Active Antiretroviral Therapy (HAART). In the era of post-HAART, manifestations of human immunodeficiency virus (HIV)-associated cardiomyopathy with impaired left ventricular (LV) systolic function are approximately about 1-3% of HIV-infected people. In this case, we presented how to diagnose and appropriately manage such a patient. Case Illustration: A 27-year-old male patient who works as a health worker came to the emergency room with complaints of shortness of breath; it worsened in the last 2 weeks. He got vital signs: blood pressure 97/60 mmHg, heart rate 118 bpm, respiratory rate 23 tpm, and oxygen saturation 99 % with oxygen supplementation of 8 lpm. Risk factors in patients such as smoking, family history, hypertension, diabetes mellitus, and dyslipidemia were denied. He was diagnosed with HIV on (antiretroviral therapy) ART 3 years ago with risk factors for free sex without protection. The last CD4 value was 796 cells/ul (normal value 637 – 1485). The echocardiography showed all chamber dilatation, global hypokinetic, and a significant decrease in LV systolic function (LVEF 16%). Laboratory examination showed an increase of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) into 6824 pg/mL (normal value <85.8). It was then treated by optimizing HF therapy continue HIV therapy. Conclusion: In HIV patients who have fallen into heart failure, a proper diagnosis using relevant tools could be a reference for clinicians to make the right decision. Prompt treatment combination of optimal HF therapy and HIV therapy are becoming the keys to the treatment. Keyword: antiretroviral, cardiomyopathy, heart failure, human immunodeficiency virus

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.

Ocular manifestations in HIV patients attending a tertiary care hospital in Eastern India and correlation of posterior segment lesions with CD4+ counts.

We aimed to study the ocular manifestations in human immunodeficiency virus (HIV)-infected patients and the correlation of posterior segment lesions with CD4+ counts. This hospital-based, cross-sectional study enrolled HIV-positive patients attending the ophthalmology department of a tertiary care hospital in Eastern India. Complete demographic information was obtained for each patient. Comprehensive ophthalmic evaluation was done in each case. A total of 184 HIV-positive patients were enrolled in the study. Ocular manifestations were detected in 62 cases. The prevalence of ocular manifestations in the present study was 33.69%. Mean age of patients included in the study was 34.8 ± 10.77 years. Prevalence of ocular manifestations was highest in the age group of 30-39 years (41.93%). Highest prevalence of ocular manifestations was noted in patients with low level of education and poor socioeconomic status. Sexual transmission was the major route of HIV transmission (in 92% of cases). Posterior segment lesions were seen in 69.35% of cases. HIV retinopathy was the most common posterior segment manifestation noted in 25 eyes. Significant positive correlation was noted between severities of posterior segment findings and CD4+ counts, which we found to increase with decrease in CD4+ counts (P < 0.001). Detailed ophthalmic evaluation including fundus examination is must in all cases of HIV/acquired immunodeficiency syndrome (AIDS) patients as it may help in early diagnosis, treatment, and prevention of sight-threatening complications due to opportunistic infections.

Abnormal Presentation of Common Sexually Transmitted Diseases in HIV-Positive Patients: A Case Series

Abstract Mucocutaneous diseases are the most common manifestation of human immunodeficiency virus and because of abnormal presentation, diagnosis and management is a challenge for clinicians. Here, we present three cases of unusual and severe presentation of common sexually transmitted diseases, out of which two patients had ulcerative lesions in genitals and one patient had cauliflower-like growth involving the pubic and anal region.

Association of dermatological manifestations with CD4 count among people living with HIV attending tertiary care hospital of South Gujarat.

Dermatological manifestations are common manifestations of human immunodeficiency virus (HIV) disease, seen in 80% to 95% of HIV-infected patients. Dermatological manifestations are considered clinical indicators to predict and assess the underlying immune status. This study aims to document the dermatological manifestations in relation to CD4 count in people living with HIV (PLHIV). Cross-sectional study in 250 PLHIV fulfilling inclusion-exclusion criteria was conducted. Variables including sociodemographic profile, recent CD4 count (data from antiretroviral therapy center), and dermatological manifestation (physical examination) were collected. Clinical diagnosis was established, and patients were grouped according to the World Health Organization immunological staging. Majority of PLHIV (39.6%) were in the age group of 31-40 years. Males were affected more than females (1.6:1). A total of 364 dermatoses were observed; dermatological manifestation per patient ranged from 1 to 4. 32.80%. PLHIV had CD4 count >500 cells/mm3, 15.60% had CD4 count between 200-349 cells/mm3. Majority of dermatosis had infectious etiology (77.6%), out of which dermatophytosis (27.2%) was the most common infectious condition, whereas pruritic papular eruption was the most common (11.6%) noninfectious condition. A statistically significant association of CD4 count was found with dermatophytosis (P ≤ 0.001) and candidiasis (P = 0.001). The study showed a significant association between the number of dermatological manifestation and CD4 count as majority of study participants (67.2%) had CD4 <500 cells/mm3 at the time of episode of dermatosis.

Cutaneous Manifestations of Sexually Transmitted Infections

ABSTRACT Cutaneous manifestations of human immunodeficiency virus (HIV) are commonly seen in clinical practice. Almost every person living with HIV (PLWH) will present with a dermatological complaint at some point during their care. Compared with people living without HIV, PLWHs have a greater likelihood of skin eruptions because of dysregulation of the skin immune system or drug reactions. This article reviews the most common dermatological conditions in PLWHs, as well as how they typically present in clinical practice, and discusses current evidence for treatment.

Mucocutaneous Manifestations of Human Immunodeficiency Virus (HIV) Infection in Relation to the Degree of Immunosuppression

Mucocutaneous Manifestations of Human Immunodeficiency Virus (HIV) Infection in Relation to the Degree of Immunosuppression

Проявления ВИЧ-инфекции в полости рта у пациентов в зависимости от содержания CD4+ Т-лимфоцитов в крови

Objective - analysis and generalization of the available data on the manifestations of human immunodeficiency virus in the oral cavity depending on the number of CD4+ T-lymphocytes in the blood. Materials and methods. A search of clinical studies, systematic reviews, and online meta-analyses was conducted from 2004-2023 in the PubMed, Elsiever, Scopus, Cochrane, and Elibrary databases, which described oral manifestations of HIV infection as a function of CD4+ T-lymphocyte count. Results. Pseudomembranous candidiasis, hairy leukoplakia, Kaposi's sarcoma, and non-Hodgkin's lymphoma develop against a background of severe immunodeficiency when the CD4+ T-lymphocyte count is &lt;200 cells/μL blood. Kaposi's sarcoma also develops in people with a high CD8+ T-lymphocyte count (&gt;1000 cells/μL of blood) or with a low CD4+ to CD8+ ratio (CD4+:CD8+ ≤0.5). Non-Hodgkin's lymphoma develops not only with CD4+ T-cells &lt;200/μL, but also with a high number of CD8+ T-cells (≥2000 cells/μL of blood). Specific periodontal disease develops with moderate to severe immunodeficiency (CD4+ T-cells 200-500 cells/μL of blood). Necrotic ulcerative gingivitis is more often seen in severe immunodeficiency (CD4+ T-lymphocytes &lt;200 cells/μL). Conclusion. The development of pseudomembranous candidiasis (p&lt;0,05), "hairy" leukoplakia (p&lt;0,01), Kaposi sarcoma (p&lt;0,0001) statistically significantly correlates with CD4+ T-lymphocyte count &lt;200 cells/μl blood. In addition, the development of Kaposi's sarcoma, in addition to the low number of CD4+ T-cells, is affected by a high number of CD8+ cytotoxic lymphocytes &gt;1000 cells/μL (p=0.0003) and a low CD4+:CD8+ ratio ≤0.5 (p&lt;0.0003), which is statistically significant.

Atypical hemolytic uremic syndrome in a patient with HIV treated with eculizumab: A case report

Thrombotic microangiopathy defines a group of pathologies characterized by microvascular dysfunction with the concurrence of microangiopathic hemolytic anemia, thrombocytopenia, and organ damage. It represents the most frequent microvascular manifestation of human immunodeficiency virus (HIV) infection. We report the case of a man in the seventh decade of life with a recent diagnosis of infection by HIV, who develops hemolytic uremic syndrome, requiring continuous renal replacement therapy and plasma replacement therapy, without response, ADAMTS13 with preserved activity, ruling out other etiologies (infectious, metabolic, and genetic) with successful response to eculizumab.

Adverse reactions and cardiac arrhythmias related to antiretroviral use in patients with HIV/AIDS

Introduction: AIDS is an advanced clinical manifestation of human immunodeficiency virus (HIV) infection. These patients have improved with antiretroviral drugs; but there is an increased risk of toxicity and cardiac disease, including cardiac arrhythmias. Objective: To clinically characterize patients with HIV/AIDS who presented adverse reactions due to the consumption of antiretroviral, as well as to estimate the prevalence ratio of cardiac arrhythmias. Method: Descriptive and cross-sectional study, which made possible the clinical characterization and the relationship of ART with general adverse reactions, including cardiac arrhythmias, in the General Clinical-Surgical Teaching Hospital Dr. “Juan Bruno Zayas Alfonso” in the period 2018-2020. Results: Adverse reactions related to oropharyngeal candidiasis were marked, representing 80%. Antiretroviral treatment was very unfavorable for Scheme I, with 66.6% of adverse reactions. Esophagus-gastritis and cardio toxicity marked the differences, with 28 (53.8%) and 14 (55.8%) respectively. The ratio between patients with cardiac arrhythmias versus those without arrhythmias is reasonably higher in those who consumed antiretroviral compared those who did not consume it. Conclusion: Adverse reactions in patients with HIV/AIDS continue to be a health problem in our territory, demonstrating the relationship between adverse reactions and antiretroviral treatment with Cuban generics, especially due to gastrointestinal effects and cardiac arrhythmias. The drug-disease interaction results a complex but indisputably frequent process in patients with HIV/AIDS.

Retroviral Disease and Smoking – A Sinister Combination causing Hyperkeratotic Laryngeal Papilloma

Introduction Otorhinolaryngologic manifestations account for almost 80% of the various manifestations of Human Immunodeficiency Virus (HIV) infection, of which Human Papilloma Virus (HPV) associated laryngeal papilloma and laryngeal malignancy are the most common pertaining to larynx. Case Report A 55year old male patient on Antiretroviral treatment since 10 years who was a chronic smoker, presented with difficulty in breathing and hoarseness of voice. Flexible laryngoscopy revealed a white, horny, wide based keratotic lesion completely covering rima glottidis resulting in obstruction of airway and stridor. Tracheostomy was done followed by endoscopic excision of the lesion. Histopathologic examination showed features of hyperkeratotic papilloma and lesion was tested negative for HPV. Discussion We report this case to emphasize on the differential diagnosis of laryngeal papillomatous lesion. A hyperkeratotic papilloma, with a dual aetiology of retroviral disease and smoking, presenting with stridor, the lesion being negative for HPV infection makes it uncommon from other laryngeal lesions.

Association of serum vitamin B12 with immuno-hematological parameters in treatment-naive HIV positive cases.

The manifestations of human immunodeficiency virus (HIV) infection and vitamin B12 deficiency overlap each other, so early diagnosis and intervention is important. The study aims to find out serum vitamin B12 level and its association with CD4 and CD8 count, clinical-staging, and hemato-biochemical status in newly diagnosed HIV positive cases. Fifty-five confirmed HIV cases above 18 years of age and equal number of age and sex matched controls were recruited for the study. CD4 and CD8 counts were analyzed by Flow cytometer. Complete Blood Count, Serum vitamin B12, Folic acid, ferritin, and C-Reactive Protein (CRP) concentration were done. Serum vitamin B12 was observed to be significantly low in HIV positive cases than healthy controls with a mean value of 240.62 ± 56.75 pg/ml and 317.57 ± 52.56 pg/ml, respectively. Decreased CD4 counts with elevated levels of ferritin and CRP was seen in HIV positive individuals. The subgroup analysis based on the levels of vitamin B12 was directly proportional to CD4 counts. CD8 counts also registered a significant association with serum B12 level, yet the response is not proportionate with the level of vitamin B12 deficiency. Nearly one-third of HIV positive cases revealed vitamin B12 deficiency. During the early stage, fast dividing immune cells cause increased consumption of micronutrients contributing toward vitamin B12 deficiency. It contributes to disorders in methylation affecting the immune function and NK Cell activity which increases the number of CD8 cells. Hence, vitamin B12 is a beneficial immunological modulator of HIV infection and can be a potent game changer in resource constrained set up.

Occurrence of vernal keratoconjunctivitis in children infected with human immunodeficiency virus.

Purpose:To study the occurrence of vernal keratoconjunctivitis (VKC) as an ocular manifestation of human immunodeficiency virus (HIV) in pediatric patients.Methods:A retrospective study was done on the observations of cases of HIV-positive children. All seropositive patients from the Anti-Retroviral Therapy clinic were referred to the department of ophthalmology for evaluation. Retrospective correlation of CD4 count with active cases of VKC was done. All patients underwent a comprehensive ophthalmic evaluation including visual acuity, slit lamp and dilated fundus examination.Results:A total of 72 children were included, 70 males and 2 females. Of these, 63 (87.5%) had VKC, three (4.2%) had cataract, two (2.8%) had cytomegalovirus retinitis retinitis, and four (5.5%) had no ophthalmic findings.Conclusion:There is a an evident association of HIV, VKC cases, and reduced CD4 count. More research is required on this topic.

Cerebral Venous Thrombosis as The Sole Presenting Manifestation of Human Immunodeficiency Virus and Hepatitis B Virus Co-Infection.

Cerebral venous thrombosis (CVT) following either human immunodeficiency virus (HIV) infection or hepatitis B virus (HBV) infection is a very rare condition. Moreover, it has never been reported as the presenting manifestation of HIV and HBV co-infection, even more so when the patient had a normal CD4 count and no demonstrable opportunistic infections. We aimed to report the first case of an adult Indian male, an intravenous drug abuser who developed CVT as the presenting manifestation of HIV-HBV co-infection. Patient data were obtained from medical records from the Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India. A 25-year-old male with a history of intravenous drug abuse and a normal CD4 count developed CVT as the presenting manifestation of HIV-HBV co-infection. His CD4 count was normal, and he had no demonstrable opportunistic infections. He had an uneventful recovery of the condition (CVT) following the institution of conventional anticoagulation therapy alongside anti-retroviral therapy. Whether illicit drug abuse or HIV/HBV infection itself or all in combination led to this thrombotic event cannot be precisely established. Notwithstanding, we recommend serologic testing for HIV and HBV in patients suffering from CVT with high-risk behavior.

"Oral manifestations of HIV in accordance with CD4 count" - A cross-sectional study.

Mouth acts as a mirror for most of the underlying systemic diseases. Very few studies were done in south Indian population to observe the oral manifestations of human immunodeficiency virus (HIV) in relation to the cluster of differentiation 4 (CD4) count, and this study mainly highlights the presenting complaint of HIV patients during their dental visit. The study was aimed to determine the chief complaints of patients along with oral manifestations of HIV and correlate them to CD4 count. One hundred consecutive HIV-positive patients were considered for the study. All the oral manifestations and the chief complaints along with the calculated CD4 counts were noted and the results were correlated. Spearman correlation was used for CD4 count and other oral manifestations. The mean CD4 counts were 421 cells/mm3 with a standard deviation (SD) of 404.34 for the most common oral manifestation of burning mouth and 176.5 cells/mm3 for the least common manifestation of malignancies. The CD4 count ranged from 120 to 1100 cells/mm3. The mean age and CD4 count were 38 years and 398.86, respectively. There was a statistically significant correlation with candidiasis and gingivitis, and the rest of the conditions were insignificant. The study results suggest that the chief complaint of presentation of an HIV-positive patient is pain due to carious teeth/abscess followed by burning mouth, with candidiasis being the most common disease.

Ventricular and atrial functions assessed by speckle-tracking echocardiography in patients with human immunodeficiency virus.

Antiretroviral therapy (ART) has dramatically changed the clinical manifestation of human immunodeficiency virus (HIV) associated cardiomyopathy from severe left ventricular (LV) systolic dysfunction to a pattern of subclinical cardiac dysfunction. The aim of this study was to evaluate by speckle tracking echocardiography (STE) LV, right ventricular (RV), and biatrial functions in HIV-infected patients under different ART combinations. We consecutively included 128 HIV-infected patients (mean age 44.2 ± 10.1 years, 110 males) and 100 controls (mean age 42.1 ± 9.4 years, 83 males). Ventricular and atrial functions were assessed by both conventional and STE. Although there was not any significant difference in conventional echocardiographic variables, HIV-infected patients had significantly lower LV global longitudinal strain (GLS), RV GLS, left atrial (LA) reservoir and conduit strain, and right atrial conduit strain. HIV patients receiving integrase strand transfer inhibitors and protease inhibitors (PI) had significantly lower LV GLS and LA conduit strain, while patients receiving non-nucleoside reverse transcriptase inhibitors and PI had significantly lower RV GLS than controls. CD4 count at the time of echocardiography was strongly correlated with LV GLS (r = .619, P < .001) and RV GLS (r = .606, P < .001). Biventricular and atrial functions are subclinically impaired in HIV-infected patients. ART regimen may also affect myocardial functions.

Hematological profile of human immunodeficiency virus-infected children

Background: Hematological disorder has been shown to be one of the leading manifestations of human immunodeficiency virus (HIV) infection. This could be from the virus itself or the accompanying opportunistic infections including malignancies. The manifestations include among others, anemia, leukopenia and thrombocytopenia. Objectives: The objective of this study is to determine the prevalence of anemia, leukopenia, and thrombocytopenia as well as assessing the relationship between antiretroviral therapy (ART) regimen and anemia. Materials and Methods: The study was a prospective study among HIV-infected children and adolescents aged 2 years to

Cutaneous manifestations of human immunodeficiency virus/acquired immunodeficiency syndrome: A comprehensive review

Background: Cutaneous manifestations of human immunodeficiency virus (HIV) may be among the initial signs of HIV-related immunosuppression. As such, recognizing HIV-related cutaneous manifestations may lead to the early diagnosis of HIV infection, enabling the prompt initiation of antiretroviral therapy. Purpose: The objective of this article is to discuss the disease history, clinical findings, serologic findings, and treatment options of cutaneous manifestations of HIV. Methods: A nonsystematic review of the literature was performed using PubMed/MEDLINE and Scopus from which relevant articles were analyzed and summarized in the article. Results: There are a number of dermatologic conditions associated with HIV infection, which can be grouped into various categories: acute HIV infection, bacterial infections, viral infections, fungal infections, parasitic infections, papulosquamous dermatoses, eczematous dermatoses, and miscellaneous disorders. Skin-related disorders observed in HIV may result from the viral infection itself or from opportunistic infections or skin disorders secondary to the immunocompromised state inherent to the infection. Many associated skin diseases are more severe in HIV-infected patients, particularly those with severe immunosuppression as seen in acquired immunodeficiency syndrome. Conclusion: Prompt recognition of these skin manifestations is critical to the initiation of disease-modifying antiretroviral therapy.

Effects of CD4 cell count and antiretroviral therapy on mucocutaneous manifestations among HIV/AIDS patients in Yunnan, China

The affecting factors of mucocutaneous manifestations inhuman immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients remain unclear in China. A retrospective analysis was conducted among HIV/AIDS patients in Yunnan, China. The demographic data, mucocutaneous manifestations, CD4 cell counts, and antiretroviral therapy (ART) regimens were collected. The effects of CD4 cell count and ART on the spectrum of mucocutaneous manifestations were evaluated. Among 508 HIV/AIDS patients, 86.0% of cases showed mucocutaneous manifestations. The average CD4 cell count (176 cells/μl) of the patients with manifestations was significantly lower than those without manifestations (328 cells/μl) (P<0.001). Diseases such as herpes zoster, oral candidiasis, condyloma acuminatum, genital herpes, oral leukoplakia, talaromycosis, cryptococcosis, and HIV-PPE (pruritic papular eruption) were represented quite frequently in patients with CD4 cell count <200 cells/μl (P<0.05), but eczema was suffered by those with CD4 cell count ≥200 cells/μl (P<0.05). ART could decline the incidence of herpes zoster, oral candidiasis, condyloma acuminatum, genital herpes, oral leukoplakia, talaromycosis, and cryptococcosis (P<0.05). Mucocutaneous manifestations are closely related to the CD4 cell count and can be used as early predictors of HIV/AIDS and immune status in clinic. ART could reduce the incidence of certain mucocutaneous manifestations.

The ocular manifestations of human immunodeficiency virus and syphilis coinfection

Objective: To investigate the ocular manifestations of human immunodeficiency virus (HIV) and syphilis coinfection. Methods: A retrospective analysis of the ocular manifestations was carried out in 27 patients (54 eyes) diagnosed as syphilis and HIV coinfection by the Department of Infectious Medicine in Peking Union Medical College Hospital during the years of 2006-2017. The research included 26 males and 1 female, aging from 24 to 76 years old, with a mean age of 40.40±12.94 years old. Ocular anterior segments were examined with slit-lamp microscope. Fundus examinations were conducted with papillary dilation, fundus photography. Results: At the first visit, there were 2 eyes without light perception, 4 eyes with light perception, 1 eye with hand movement, 1 eye with finger counting, 2 eyes with 0.01-0.09 eyesight, 8 eyes with 0.1-0.2 eyesight, 12 eyes with 0.25-0.4 eyesight, 15 eyes with 0.5-0.9 eyesight, 9 eyes with 1.0-1.5 eyesight. Among the 27 patients (54 eyes) coinfected with HIV and syphilis, keratic precipitates were identified in 20 eyes, aqueous flare positive in 20 eyes, float positive in 15 eyes, and iris posterior synechias in 7 eyes. Nineteen eyes were diagnosed as syphilis uveitis, including 2 eyes with syphilis anterior uveitis and 17 eyes with syphilis panuveitis, among which, vitreous inflammatory opacity was observed in all 19 eyes, disk atrophy in 2 eyes, optic edema in 1 eye, vitreous hemorrhage in 1 eye, retinal detachment in 2 eyes, retinal hemorrhage and white vein in 1 eye. In addition, 8 eyes were diagnosed as HIV retinopathy, all manifested as cotton-wool spot. Among the 8 eyes, 4 were diagnosed as cytomegalovirus retinitis, 3 showed retinal yellow-white lesions, and 1 was in late phase which showed retinal pigmentation. The incidence of both HIV and syphilis coinfection patients and male homosexuality population increased. The most common ocular manifestation of HIV and syphilis coinfection was syphilis panuveitis. Six patients first visited the Department of Ophthalmology, and were then diagnosed as HIV and syphilis coinfection. Conclusions: The ocular manifestations of HIV and syphilis coinfection are diversified, which can be manifested as fundus necrotic lesions as well as anterior and posterior inflammatory. For HIV positive patients, syphilis serologic test should be routinely performed. The same, syphilis positive patients should be tested for HIV serum antibodies, in order to improve the diagnosis level of HIV/syphilis coinfection and give timely etiological treatment, which is of vital importance for saving visual acuity. (Chin J Ophthalmol, 2019, 55:267-272).