Human Immunodeficiency Virus Markers Research Articles

Treatment-mediated changes in human immunodeficiency virus (HIV) type 1 RNA and CD4 cell counts as predictors of weight growth failure, cognitive decline, and survival in HIV-infected children.

This meta-analysis of 5 large studies of the Pediatric AIDS Clinical Trials Group was undertaken to evaluate the predictive value of antiretroviral treatment-mediated changes in 3 markers of human immunodeficiency virus (HIV) type 1 disease progression-HIV-1 RNA level, CD4 cell count, and CD4 percentage-for weight growth failure, cognitive decline, and survival in HIV-infected children. Proportional hazards models were used to assess the prognostic value of the markers at baseline and after 24 weeks of treatment, with data from 1089 children. Among children receiving nucleoside with or without nonnucleoside reverse-transcriptase inhibitors, higher immunologic and lower virologic markers at baseline and after 24 weeks were significant independent predictors of survival, whereas virologic markers were significant predictors of weight growth and cognitive failure in children >1 year old. The finding of differential age effects on pediatric-specific clinical outcomes emphasizes the need for continued investigation of treatment effects in children.

TT virus infection during chronic hepatitis C

OBJECTIVE: The pathogenic role of TT virus (TTV) is not well known, especially during chronic hepatitis C virus (HCV) infection. We retrospectively investigated the presence of TTV DNA in the plasma of patients with chronic HCV infection and compared the characteristics of TTV-DNA–positive and -negative groups. METHODS: Between November 1996 and November 1998, 234 patients were included. Inclusion criteria were persistently elevated serum alanine aminotransferase (ALT) levels, anti-HCV and HCV-RNA positivity, and seronegativity for hepatitis B virus and human immunodeficiency virus markers. TTV DNA was amplified in nested polymerase chain reaction with TTV-specific primers, and products were analyzed by agarose-gel electrophoresis. Data were analyzed using the χ 2, Fisher’s exact test, or Mann-Whitney test, as appropriate. RESULTS: TTV DNA was detected in 19 (8.1%; 95% confidence interval: 4.6–11.6%) patients. TTV-DNA–positive and TTV-DNA–negative patients did not differ statistically for age, gender ratio, source of HCV infection, HCV disease duration, biological parameters, histological grade, HCV-RNA load, or HCV genotype. Although nonsignificant ( p = 0.21), there was a trend for a higher prevalence of TTV DNA in patients with an unknown cause of HCV infection (4/22, 18.2%) than in intravenous drug users (4/84; 4.8%), in those exposed to potential risk factors (4/49; 8.2%), or in those having received blood transfusion (7/79; 8.9%). CONCLUSIONS: Because the rates of HCV replication and the severity of liver lesions in TTV-DNA–negative and -positive patients were similar, the hepatic pathogenicity of TTV in chronic hepatitis C patients is questionable.

TT virus infection during chronic hepatitis C.

The pathogenic role of TT virus (TTV) is not well known, especially during chronic hepatitis C virus (HCV) infection. We retrospectively investigated the presence of TTV DNA in the plasma of patients with chronic HCV infection and compared the characteristics of TTV-DNA-positive and -negative groups. Between November 1996 and November 1998, 234 patients were included. Inclusion criteria were persistently elevated serum alanine aminotransferase (ALT) levels, anti-HCV and HCV-RNA positivity, and seronegativity for hepatitis B virus and human immunodeficiency virus markers. TTV DNA was amplified in nested polymerase chain reaction with TTV-specific primers, and products were analyzed by agarose-gel electrophoresis. Data were analyzed using the chi2, Fisher's exact test, or Mann-Whitney test, as appropriate. TTV DNA was detected in 19 (8.1%; 95% confidence interval: 4.6-11.6%) patients. TTV-DNA-positive and TTV-DNA-negative patients did not differ statistically for age, gender ratio, source of HCV infection, HCV disease duration, biological parameters, histological grade, HCV-RNA load, or HCV genotype. Although nonsignificant (p = 0.21), there was a trend for a higher prevalence of TTV DNA in patients with an unknown cause of HCV infection (4/22, 18.2%) than in intravenous drug users (4/84; 4.8%), in those exposed to potential risk factors (4/49; 8.2%), or in those having received blood transfusion (7/79; 8.9%). Because the rates of HCV replication and the severity of liver lesions in TTV-DNA-negative and -positive patients were similar, the hepatic pathogenicity of TTV in chronic hepatitis C patients is questionable.

19] Inactivation of viruses in human plasma

Human flesh frozen plasma (FFP) is widely used for therapeutic purposes and has a high safety margin based on two complementary approaches. It is a single donor preparation isolated from donor blood or obtained by plasmapheresis. Each donation or plasma unit is tested for the absence of markers of human immunodeficiency virus (HIV) and the hepatitis viruses B and C (HBV, HCV), respectively. It is quarantined for up to 6 months in the frozen state. The plasma is not used before the respective donor or his new donation after this time period is retested and found to be negative for the viral markers mentioned. Nevertheless, there is a slight, but significant, residual risk of viral contamination as a result of donations in the preseroconversion window period of infectivity. The donor may also be infected with a virus that is not tested for—for example, parvovirus B19. This justifies incorporating a step to ensure the viral safety of FFP. For plasma pool products, heat treatment in the liquid or freeze-dried state or treatment with detergents in combination with organic solvents is routinely used. These procedures are, however, too labor, and time consuming to process numerous single donor units of FFP. In this case, a realistic approach is photodynamic treatment.

The Use of Paclitaxel and Cisplatin in a Patient with Epithelial Ovarian Cancer and Human Immunodeficiency Virus

Objective. Several reports exist of human immunodeficiency virus (HIV)-positive patients developing epithelial ovarian cancer. The optimal chemotherapeutic regimen has been unclear due to potential immunotoxicity from chemotherapy in these already immunocompromised patients. This is the first report of paclitaxel-based combination chemotherapy in an HIV-positive patient with ovarian cancer.Method. A 39-year-old woman with HIV was diagnosed with poorly differentiated serous carcinoma. She underwent optimal cytoreductive surgery and received six courses of paclitaxel and cisplatin.Results. The patient experienced a complete clinical response to therapy with no adverse effect on surrogate markers for human immunodeficiency virus (CD4 count, β2 microglobulin, neopterin, p24 antigen, and viral load).Conclusion. Paclitaxel- and platinum-based chemotherapy, the standard of care for adjuvant chemotherapy in advanced ovarian carcinoma, is appropriate therapy for ovarian cancer patients with HIV. There is no evidence that the paclitaxel/cisplatin regimen is associated with progression of HIV or increased chemotherapy-associated morbidity.

Cytokines, plasma immune activation markers, and clinically relevant surrogate markers in human immunodeficiency virus infection.

Laboratory surrogate markers of human immunodeficiency virus (HIV) infection are needed to provide information about the stages and course of disease, especially in the years prior to the development of clinical signs and symptoms of immune disorder, e.g., opportunistic infections or neoplasia.

History of syringe sharing in prison and risk of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus infection among injecting drug users in Berlin

Injecting drug users (IDU) are at risk of parenterally transmitted diseases such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infection. We investigated whether a history of syringe sharing in prison is a risk factor for these infections. In the longitudinal part of the study, HBV, HCV, and HIV seroincidence rates were determined. The participants were recruited by multisite-sampling at different agencies for IDU. Data on risk behaviour were obtained by a standardized questionnaire. Serological markers for HBV, HCV, and HIV were determined. Logistic regression analysis was performed to adjust for confounding effects. A history of syringe sharing in prison was significantly associated with HBV (adjusted prevalence odds ratio [POR] = 3.9, 95% confidence interval [CI]: 2-10), HCV (POR = 9.7, 95% CI: 3-33), and HIV infection (POR = 10.4, 95% CI: 4-29). The HIV seroincidence rate was 5.9 per 100 person-years. None of the IDU receiving methadone maintenance treatment (MMT) seroconverted whereas the HIV incidence was 8.5 among IDU not in MMT (P = 0.01). The increased risk of HBV, HCV, and HIV infection among IDU who had shared syringes in prison warrants specific preventive action. The longitudinal data suggest that IDU in MMT have a lower risk of HIV infection.

Zidovudine safety and tolerance among uninfected healthcare workers: A brief update

e W initiated a collaborative study of the safety and tolerance of zidovudine treatment for postexposure prophylaxis of occupational exposures in >14 institutions soon after the drug was licensed. Our study was not designed to evaluate treatment efficacy, since the number of expected exposures was too small to provide sufficient power for an assessment of this outcome. However, we were interested in addressing several questions relevant to exposed workers and their treating clinicians: (1) what is the prevalence, severity, and temporal sequence of adverse events associated with drug treatment; (2) what is the effect of zidovudine treatment on the temporal sequence of markers of human immunodeficiency virus (HIV) infection, should it occur; (3) what is the epidemiology of HIV exposures for which postexposure treatment was elected; and (4) what is the feasibility of implementing a postexposure treatment program. Updates on the progress of this study have been presented.‘-’ As of March 1996, >250 healthcare workers have been enrolled. Preliminary findings to date include the following: 1. Initiation of postexposure treatment within 4 hours of exposure appears to be a feasible goal, even for exposures occurring at night and on weekends; 2. Symptoms of drug intolerance (nausea, fatigue, headache, etc.) occurred in a substantial number of subjects and in some, contributed to the decision to stop treatment. No unexpected symptoms attributable to zidovudine developed; 3. No laboratory toxicities requiring dose adjustment or discontinuation have been observed to date.

Sexual transmission of hepatitis B in Mwanza, Tanzania.

Hepatitis B virus (HBV) is endemic and poses a grave public health problem in Africa where it is mainly transmitted from mother to baby or during childhood. Sexual transmission has also been suggested to play a role in East Africa, but this has never been properly demonstrated. Additional preventive strategies may be proposed if sexual transmission of HBV occurred in this region where HIV and other STDs are highly prevalent. To determine the prevalence of markers for hepatitis B virus (HBV)and other sexually transmitted diseases (STD) in routine blood samples taken from three populations in Mwanza, Tanzania, and to use the data collected to look at the association between hepatitis B and other STDs, including human immunodeficiency virus (HIV). Routine blood samples were collected from 1,025 patients attending a clinic for STDs, 253 voluntary blood donors from secondary schools, and 952 blood donors who gave blood in a hospital specifically for a relative who needed a blood transfusion. All samples were tested for HIV by double enzyme-linked immunosorbent assay (ELISA), and for syphilis using the Treponema pallidum hemagglutination (TPHA) and rapid plasma reagin (RPR) tests. Two markers for HBV were examined by the double ELISA method, the presence of the anti-hepatitis B core antigen (anti-HBc) and the hepatitis B surface antigen (HBsAg). There were high prevalences of HBV, syphilis, and HIV in relative donors and STD patients. Although HBV markers were more prevalent in men of increasing ages, syphilis and HIV markers were more prevalent in young women. Evidence of past infection with HBV (presence of anti-HBc) was associated with serologic markers of recent treponemal infection (both TPHA and RPR positive) in both sexes (men odds ratio [OR] = 1.91, P < 0.011; women OR = 2.34, P < 0.02) and with HIV in men (OR = 1.93, P < 0.003). Current infection with HBV (presence of HBsAg) was associated with recent syphilis in men (OR = 2.13, P < 0.006). In STD patients, current infection with HBV was associated with Trichomonas vaginalis in women (OR = 3.57, P < 0.002) and recent syphilis in men (OR = 3.46, P < 0.001). There was no further association between HBV markers and any other STD pathogen or any particular STD syndrome, nor was there any association between current HBV infection and HIV in both sexes. The population attributable fraction for sexual acquisition of hepatitis B is estimated at 7.2% in men and 3.0% in women, based on the association between hepatitis B and syphilis. These findings suggest that sexual acquisition of hepatitis B occurs at low levels in Mwanza, and that HBV can be prevented through enhancement of the current HIV/STD control activities, in addition to improved vaccination strategies.

The seroprevalence of hepatitis B, hepatitis C and human immunodeficiency virus infections in paediatric oncology patients in Turkey.

One hundred and two newly diagnosed children with malignancy followed up at the Pediatric Oncology Department of Ankara Oncology Hospital were investigated for hepatitis B, hepatitis C and human immunodeficiency virus markers. The ages ranged between seven months and 17 years with a median of 10 years; 62 were male. Twenty-four patients had Hodgkin's disease, 11 had non-Hodgkin's lymphoma and 67 patients had other solid tumours. Four patients had positive HBs-Ag, 15 developed immunity against hepatitis B and had anti-HBs antibodies. One patient had a previous infection with positive anti-HBc. Hepatitis C virus antibodies were positive in only one patient. HIV serology was negative in all patients. These results show the high prevalence of hepatitis B virus infection in paediatric oncology patients. In countries where hepatitis B is endemic, strict screening of blood donors, usage of disposable equipment and vaccination of patients is recommended. Although the incidence of hepatitis C and human immunodeficiency virus infections are rising, infection with hepatitis B is still by far the most common.

Occupational risk of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infections among funeral service practitioners in Maryland.

To estimate the risk of exposure and infection with bloodborne pathogens, a seroepidemiologic survey was conducted among funeral service practitioners (FSPs) in Maryland. Of 262 members of the Maryland State Funeral Directors Association, 130 (49%) volunteered to participate in the study. In addition to a brief questionnaire, designed to assess both occupational and non-occupational risk factors for bloodborne pathogen infection, participants were screened for markers of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and past hepatitis B virus (HBV). Titers for antibodies to hepatitis B surface antigen (anti-HBs) also were examined and compared with history of hepatitis B vaccination. Seroprevalence for HIV, HBV, and HCV infection was 0.8%, 4.6%, and 0%, respectively. Nearly 19% of participants reported at least one bloodborne exposure in the past 6 months. The one HIV infection and all but two of the HBV infections were correlated with well-established non-occupational risk behaviors. Disposable gloves were worn by 96%, and eating, drinking, or smoking during embalming were infrequent. Sixty-one percent of FSPs reported having received one or more doses of hepatitis B vaccine at some time in the past. Of those who reported having received all three doses of vaccine, 67% had adequate titers to hepatitis B surface antibody, the marker of protection related to vaccination. Compared with prior studies of FSPs, this study found a low rate of occupational exposures and a high rate of hepatitis B vaccination, suggesting improved compliance with recommendations for preventing transmission of bloodborne pathogens in the workplace.

Prevalence of hepatitis B, hepatitis C, and human immunodeficiency virus markers among hospital employment applicants.

To delineate baseline seroprevalence rates before job placement, applicants for employment (n = 300) at a large urban medical center were screened for serologic markers to the hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) during a 15-week period in 1992. Eighteen applicants (6%) were positive for antibodies to HBV, nine (3%) for HCV, and 3 (1%) for HIV. There was no association by gender for any of these viral markers; however, both HBV and HCV were significantly more often detected in persons applying for hourly positions who were black. In an urban setting, preemployment screening of health care workers for HBV and HCV markers appears warranted, and serum banking for later HIV analysis, should a claim arise, is suggested.

Distribution of viral genotypes in Italy determined by hepatitis C virus typing by DNA immunoassay

The distribution of hepatitis C virus (HCV) genotypes in Italy was investigated by PCR amplification of the E1 region and hybridization with type I- and type II-specific nonisotopic probes. Positive PCR results were obtained for 65 of 72 patients (90.3%). Type I was detected in 13 of 72 patients (18%), type II was detected in 39 patients (54.2%), and a mixed type I-type II infection was detected in 7 patients (9.7%). Six amplification products not classified by this method shared a low level of homology with HCV types I and II. HCV type I was significantly associated with human immunodeficiency virus, whereas HCV type II was detected in older subjects who were negative for human immunodeficiency virus markers. These results indicate different epidemiological distributions of HCV types I and II in Italy.

Coinfection With Human T-Cell Lymphotropic Virus Type I and HIV in Brazil

To study the effect of human T-cell lymph-tropic virus type I (HTLV-I) on markers of human immunodeficiency virus (HIV) disease progression. A retrospective, nested case-control study. A university hospital outpatient HIV clinic in Rio de Janeiro, Brazil. Human immunodeficiency virus-seropositive adults participating in a prospective HIV cohort study. The HIV clinical stage, CD4+ lymphocyte counts, and other laboratory parameters in 27 individuals infected with HIV and HTLV-I (coinfection) and 99 age-matched, HIV-seropositive, HTLV-seronegative controls (single infection). Variables independently associated with coinfection included higher CD4+ lymphocyte count (odds ratio [OR], 2.3; 95% confidence limits [CL], 1.3, 4.1), higher CD4+ percentage (OR, 2.0; 95% CL, 1.3, 3.2), beta 2-microglobulin level of 254 nmol/L or more (OR, 6.8; 95% CL, 1.3, 35.4), World Health Organization stages 3 and 4 (OR, 4.4; 95% CL, 1.1, 18.0), and reporting a parenteral risk factor (OR, 7.4; 95% CL, 1.4, 38.9). When stratified by p24 antigenemia, coinfection was associated with an estimated 82% higher CD4+ lymphocyte count (P < .05). Coinfection was associated with higher CD4+ lymphocyte counts, more advanced clinical disease, and higher beta 2-microglobulin levels than HIV infection alone. The higher mean CD4+ lymphocyte count does not appear to offer immunologic benefit. Caution should be exercised when using CD4+ lymphocytes as a surrogate marker in studies of HIV infection in populations where HTLV-I is prevalent. Further studies are needed to address whether current CD4+ lymphocyte values for the initiation of antiretroviral therapy and chemoprophylaxis against opportunistic infections in HIV infection are appropriate in coinfection.

Coinfection with human T-cell lymphotropic virus type I and HIV in Brazil. Impact on markers of HIV disease progression

<h3>Objectives.</h3> —To study the effect of human T-cell lymphtropic virus type I (HTLV-I) on markers of human immunodeficiency virus (HIV) disease progression. <h3>Design.</h3> —A retrospective, nested case-control study. <h3>Setting.</h3> —A university hospital outpatient HIV clinic in Rio de Janeiro, Brazil. <h3>Participants.</h3> —Human immunodeficiency virus—seropositive adults participating in a prospective HIV cohort study. <h3>Main Outcome Measures.</h3> —The HIV clinical stage, CD4⁺lymphocyte counts, and other laboratory parameters in 27 individuals infected with HIV and HTLV-I (coinfection) and 99 age-matched, HIV-seropositive, HTLV-seronegative controls (single infection). <h3>Results.</h3> —Variables independently associated with coinfection included higher CD4⁺lymphocyte count (odds ratio [OR], 2.3; 95% confidence limits [CL], 1.3,4.1), higher CD4⁺percentage (OR, 2.0; 95% CL, 1.3, 3.2), β₂-microglobulin level of 254 nmol/L or more (OR, 6.8; 95% CL, 1.3, 35.4), World Health Organization stages 3 and 4 (OR, 4.4; 95% CL, 1.1,18.0), and reporting a parenteral risk factor (OR, 7.4; 95% CL, 1.4, 38.9). When stratified by p24 antigenemia, coinfection was associated with an estimated 82% higher CD4⁺lymphocyte count (<i>P</i>&lt;.05). <h3>Conclusion.</h3> —Coinfection was associated with higher CD4⁺lymphocyte counts, more advanced clinical disease, and higher β₂-microglobulin levels than HIV infection alone. The higher mean CD4⁺lymphocyte count does not appear to offer immunologic benefit. Caution should be exercised when using CD4⁺lymphocytes as a surrogate marker in studies of HIV infection in populations where HTLV-I is prevalent. Further studies are needed to address whether current CD4⁺lymphocyte values for the initiation of antiretroviral therapy and chemoprophylaxis against opportunistic infections in HIV infection are appropriate in coinfection. (<i>JAMA</i>. 1994;271:353-357)

Absence of Antibody to Human Immunodeficiency Virus in Long-term, Socially Rehabilitated Methadone Maintenance Patients

Human immunodeficiency virus (HIV) infection has become widespread among parenteral drug abusers. We measured antibody to HIV and hepatitis B virus markers in 58 long-term, socially rehabilitated methadone-maintained former heroin addicts. None of the 58 had antibody to HIV, but one or more markers of hepatitis B virus infection were seen in 53 (91%). The duration of methadone maintenance was 16.9 +/- 0.5 years, and the median dose of methadone was 60 mg (range, 5 to 100 mg). Before methadone treatment, the patients had abused heroin parenterally for 10.3 +/- 1.7 years, and they had engaged in additional high-risk practices for HIV infection. We conclude that successful outcomes during methadone maintenance treatment are associated with sparing of parenteral drug abusers from HIV infection.

Prevalence of antibodies to hepatitis C virus (HCV) in haemophiliacs

The prevalence of 1) hepatitis C virus (HCV), an agent likely to be responsible for parenterally transmitted hepatitis non-A, non-B, 2) hepatitis B virus (HBV) and 3) human immunodeficiency virus (HIV) infection was studied in 211 patients with clotting disorders (78% of the patients had residual factor activities of less than or equal to 2%). Of these patients 71% were positive for HBV markers and 44% for HIV markers. Using a new ELISA technique, 80% were anti-HCV-positive. The prevalence of anti-HCV was greater in patients with more severe clotting disorders and was related to the total amount of replacement therapy received; the prevalence was less in older patients. Seroconversion after a single exposure to dry heat-treated factor concentrates was documented in 3 patients 3-4 months after exposure.

Human immunodeficiency virus infection of monoblastoid cells: cellular differentiation determines the pattern of virus replication

Stringent control of human immunodeficiency virus (HIV) replication was observed in the human monoblastoid cell line U937. A low-multiplicity infection of these cells by the LAV1 strain of HIV was productive for 2.5 days; then virus replication became restricted and no further evidence of virion production was observed. The dramatic decrease in HIV production was due in part of reduced accumulation of cytoplasmic viral RNA and occurred in the absence of evident cytopathic effects. In contrast, infected cells induced to differentiate by phorbol ester, vitamin D3, or lymphokine supernatant did not release markers of HIV despite the accumulation of significant levels of cytoplasmic viral RNA. HIV infection altered the pattern of c-myc RNA accumulation in U937 cells. Expression of this gene changes normally in response to the state of cellular differentiation; in infected cells the level of c-myc expression was correlated to the levels of viral RNA accumulation and not to cellular differentiation. These results suggest that restricted replication of HIV in monocytes might be an important mechanism of virus persistence and demonstrate a relationship between HIV replication and monocyte differentiation.

Renal cytomembranous inclusions in idiopathic renal disease as predictive markers for the acquired immunodeficiency syndrome

Tubuloreticular inclusions (TRI) and cylindrical confronting cisternae (CCC) are present in cells of patients with the acquired immunodeficiency syndrome (AIDS) and have also been detected in the kidneys of individuals with AIDS and heavy proteinuria. We examined renal biopsy tissue from 13 patients with proteinuria and/or renal insufficiency. At the time of biopsy, two of the patients had AIDS (group A), four had AIDS-related complex (ARC) (group B), and seven presented without any clinical signs or symptoms characteristic of AIDS or ARC. These seven had risk factors for AIDS, and systemic lupus erythematosus (SLE) was excluded in all. Abundant TRI were present in the renal endothelial and fibroblastic interstitial cells in all patients from group A and B and in four patients who had no evidence for AIDS or ARC at the time of biopsy (group C). These individuals were followed, and all developed AIDS within a period of 3 to 14 months. CCC were detected in two of two patients in group A, one of four in group B, and one of four in group C. TRI and CCC were not present in the renal tissue of the remaining three patients; they did not develop ARC or AIDS over a prolonged observation period. Our findings suggest that TRI and TRF are ultrastructural markers for human immunodeficiency virus (HIV) associated nephropathy and can be seen before AIDS has manifested itself. These structures may be of predictive value for the future development of AIDS in patients presenting with apparent idiopathic renal disease.

Nasopharyngeal carcinoma not associated with HIV in Sudan

Nasopharyngeal carcinoma (NPC) a cancer believed to be related etiologically to Epstein-Barr virus and the related Burkitts lymphoma has been reported with increasing frequency from the Sudan. It has been hypothesized that Epstein-Barr virus may be a co-factor in the pathogenesis of acquired immunodeficiency syndrome (AIDS) because of its immunosuppressive effects. The increasing incidence of NPC in recent years in the Sudan and its occurrence mainly in regions bordering on Central and East African countries where human immunodeficiency virus (HIV) is widespread suggest that patients with HIV infection may also have an increased incidence of NPC. To investigate this possibility 11 patients in Khartoum receiving treatment for NPC were tested for HIV markers. The average age of these patients was 21 years. 8 of these patients had received medical injections in the 5-years before the study. All 11 NPC patients were negative for HIV infection both by commercial enzyme-linked immunosorbent assay (ELISA) and Western blot assay. Although these findings suggest that NPC is not related to HIV infection in the Sudan more research is needed to assess this relationship.