Opportunistic Conditions Research Articles

Prevalence and Associated Factors of Urinary Tract Infections among Diabetes Mellitus Patients at KIU-TH from January to December 2022

Globally, an estimated 150 million individuals are affected by urinary tract infections (UTIs) every year, with a significant number of those affected being diabetics. The International Diabetes Federation (IDF) reported that in the year 2019, there were about 60 million cases of patients suffering from diabetes who developed UTIs. The study assessed the prevalence and associated factors of urinary tract infections among diabetic mellitus patients in the medical ward at KIUTH. The objectives were to find out the prevalence and the factors associated with urinary tract infections among diabetic patients in the medical ward of KIU-TH. The study was descriptive, and it involved 87 patient files selected by purposive sampling, in which a checklist was the main tool of data collection. The study showed that female gender was significantly associated with the occurrence of urinary tract infection in diabetic patients at OR 0.17 (0.05–4.29) and PV 0.01. The study also shows that having other disease comorbidities was significantly associated with the occurrence of UTI among diabetic patients at OR 0.58 (0.35-8.07) and PV 0.002. The study also shows that having late diabetic disease among diabetic patients was also significantly associated with the occurrence of UTI among diabetic patients at OR 0.69 (0.35-8.19) and PV 0.004. The study concluded that 48 (55.2%) of diabetic patients had had a urinary tract infection, and therefore the study recommends that diabetic patients should be health educated on the causes and control of UTI so as to prevent their occurrences. The study also recommends that the government increase service provisions like treatments to reduce the occurrence of opportunistic conditions in UTIs, and the patients should be encouraged to seek regular medical checkups so that they monitor disease progression. Keywords: Diabetics, UTIs, Patients, Diabetes mellitus.

Unmasked immune reconstitution inflammatory syndrome towards B-cell non-Hodgkin lymphoma during treatment of esophageal actinomycosis in a patient with advanced HIV: a case report

BackgroundActinomycosis is an unusual chronic bacterial infection, even rarer in people living with HIV. It is not considered an AIDS-defining disease. However, the role in co-presentation or overlap with other opportunistic conditions of advanced HIV is unknown.Case presentationA 49-year-old Peruvian male presented with a 4-month history of dysphagia, odynophagia, hyporexia and wasting. He underwent an upper digestive endoscopy, in which ulcers with a necrotic center were observed, therefore, the initial diagnostic assumption was esophageal cancer. Subsequent pathology report excluded neoplasms and confirmed the diagnosis of actinomycosis. Serology for human immunodeficiency virus was requested, yielding a positive result. Antimicrobial treatment with amoxicillin and antiretroviral therapy were indicated, with slow clinical improvement. After 4 months, epigastric discomfort presented, for which a new upper digestive endoscopy was performed, revealing a deep gastric ulcer, which was compatible with diffuse large B-cell non-Hodgkin lymphoma.ConclusionEsophageal actinomycosis in people living with HIV is very rare. We suggest HIV-associated immunosuppression is not enough to allow for actinomycosis to develop, and masked underlying entities should be sought. The existence of such entities in people living with HIV should raise awareness of the possibility of unmasked immune reconstitution inflammatory syndrome once treatment has started.

Risk Assessment of Venous Thrombolic Disease in Hospitalized Advanced HIV Patients in a Resource-Limited Setting

HIV infection is known to be a factor associated with cardiovascular disease. The objective of this work is to draw the attention of clinicians working in a resource-limited environment to the risk run by these patients in hospitalization in order to be able to prevent and ensure early and adequate management allowing the reduction of thrombotic risk andits complications. This is a descriptive cross-sectional study from January 2022 to May 2023, all patients hospitalized for advanced HIV disease were assessed by the Padua score supported by the D-dimer test. The data was collected in strict confidentiality. Out of a total of 400 hospitalized patients 40 were identified as being at being at risk of developing venous thromboembolic disease (VTE). The average age was 33, 6 years, 28 patients were female (70%).Coma (37,5%) and dyspnea(30%) were the main reasons for consultation. Cellular immunosuppression was severe (CD4∠200 mm3) in 95% of patients disseminated tuberculosis(50%), pneumocystosis carini pneumonia(25%), sepsis(12,5%), neuromeningeal cryptococcosis(7,5%) and Kaposi’s sarcoma (5%) were the main associated opportunistic conditions. 28(70%) patients were naïve to antiretrovirals and 12(30%) had been on retroviral treatment for six months. 12(30%) patients died, 8(20%) patients progressed well, and 20(50%) were lost sight of for lack financed mean.

Microbiome assembly mechanism and functional potential in enhanced biological phosphorus removal system enriched with Tetrasphaera-related polyphosphate accumulating organisms

Tetrasphaera-related polyphosphate accumulating organisms (PAOs) are the key functional guilds for enhanced biological phosphorus removal (EBPR) systems. Their biomass enrichment can be enhanced by the nitrification inhibitor allylthiourea (ATU). However, the underlying assembly mechanism and the functional potential of the EBPR microbiome regulated by ATU are unclear. This study investigates the effect of ATU on microbiome assembly and functional potential by closely following the microbiota dynamics in an EBPR system enriched with Tetrasphaera-related PAOs for 288-days before, during and after ATU addition. The results showed that ATU addition increased microbiota structural similarity and compositional convergence, and enhanced determinism in the assembly of EBPR microbiome. During exposure to ATU, Tetrasphaera-related PAOs were governed by homogeneous selection and the dominant species revealed by 16S rRNA gene-based phylogenetic analysis shifted from clade III to clade I. Meanwhile, ATU supply promoted significant enrichment of functional genes involved in phosphate transport (pit) and polyphosphate synthesis and degradation (ppk1 and ppk2), whereas both Nitrosomonas and ammonia monooxygenase-encoding genes (amoA/B/C) assignable to this group of nitrifying bacteria decreased. Moreover, ATU addition relieved the significant abundance correlation between filamentous bacteria Ca. Promineofilum and denitrifying Brevundimonas (FDR-adjusted P < 0.01), damaging their potential synergic or cooperative interactions, thus weakening their competitiveness against Tetrasphaera-related PAOs. Notably, ATU withdrawn created opportunistic conditions for the unexpected explosive growth and predominance of Thiothrix filaments, leading to a serious bulking event. Our study provides new insights into the microbial ecology of Tetrasphaera-related PAOs in EBPR system, which could guide the establishment of an efficient microbiota for EBPR.

A retrospective analysis of the causes of an adverse outcome in COVID-19 and HIV coinfection in the stage of secondary diseases

The increased incidence of COVID-19 and HIV coinfection and the changes in the structure of HIV infection mortality during the pandemic necessitate an analysis of the causes of adverse outcomes in co-infection. Objective. To retrospectively analyze deaths in patients with COVID-19 and HIV coinfection in the stage of secondary diseases. Subjects and methods. The investigation involved the medical records of 56 patients with laboratorily confirmed COVID-19 and HIV infection who were hospitalized in January to December 2021. Results. A retrospective analysis of the medical reports showed that bilateral polysegmental pneumonia of mixed etiologies was the cause of death in the majority cases of COVID-19 and HIV coinfection in the stage of secondary diseases. Along with pneumonia, multiple opportunistic diseases and conditions, which aggravated the course of the underlying disease, were identified in these patients. Various somatic diseases are one of the reasons for the severe course of the coinfection. Conclusion. Stage IVB HIV infection was diagnosed in the majority of deaths. Bilateral polysegmental pneumonia of mixed etiologies was the most common cause of death in patients with COVID-19 and HIV coinfection in the stage of secondary diseases.

Realizing the promise of long-acting antiretroviral treatment strategies for individuals with HIV and adherence challenges: an illustrative case series

BackgroundAdherence to antiretroviral treatment (ART) remains the cornerstone of optimal HIV outcomes, including viral suppression (VS), immune recovery, and decreased transmission risk. For many people with HIV (PWH), particularly those with early-acquired HIV, structural, behavioral, and cognitive barriers to adherence and competing priorities related to life events may be difficult to overcome, resulting in nonadherence. Long-acting injectable antiretroviral therapies (LAI-ART) may be a useful strategy to overcome some of these barriers. However, to date, the approved LAI-ART strategies (e.g., cabotegravir and rilpivirine (CAB/RPV)) have targeted those who have already attained viral suppression, precluding their use in the 40% of adolescents and young adults (AYA) that VS has eluded.Case presentationMs. X is a 30-year-old woman with perinatally-acquired HIV and barriers to adherence. Despite many interventions, she remained persistently viremic, with resultant immune suppression and multiple comorbid opportunistic conditions, and viral load (VL) > 10,000,000 copies/ml. Given her longstanding history of poor adherence to an oral regimen, a switch to monthly intramuscular (IM) injections and biweekly infusions of ibalizumab were initiated leading to decreased viral load to 8,110 copies/ml within two weeks. Ms. H is a 33-year-old woman with cognitive limitations due to childhood lead poisoning. Her viral load trajectory took a downward turn, precipitated by various life events, remaining elevated despite intensive case management. Initiation of LAI-ART (CAB/RPV) in this patient led to an undetectable VL (< 20 copies/ml) within two months of treatment initiation. Miss Y. is a 37-year-old woman with perinatally-acquired HIV and chronic challenges with nonadherence and longstanding immunosuppression with CD4 < 200 cells/mm3 for > 5 years. She received a 1-month oral lead-in (OLI) of cabotegravir/rilpivirine, followed by the injectable loading dose. She has since adhered to all her monthly dosing appointments, sustained VS, and transitioned to a bi-monthly injection schedule.ConclusionThese three individuals with HIV (perinatally and non-perinatally acquired) with longstanding nonadherence and persistent viremia were successfully initiated on LAI-ART through the process of care coordination and the collective efforts of the care team, highlighting the barriers, challenges, and the multidisciplinary coordination needed to assure successful implementation of this strategy for the most vulnerable of patients.

Oral and maxillofacial manifestations of human immunodefficiency virus infection

Oral manifestations occur at all stages of human immunodeficiency virus (HIV) infection. Their clinical expressions and severity depend on the evolution of the infection and become critical at the stage of acquired immunodeficiency (AIDS). They are essentially infectious, tumoral, and, starting a few years ago, iatrogenic. Infections are mostly fungal (candidiasis), viral (herpes, zoster, human papillomavirus infections, etc.), and less frequently bacterial (streptococcemia). Cases of sexually transmitted diseases, particularly syphilis, are multiplying preoccupyingly. The most frequently observed tumors are Kaposi's sarcoma. Drug intolerance is common; the symptoms are mostly dermatological, but also oral (Stevens-Johnson syndrome and toxic epidermal necrolysis) when sulfonamides and certain antiretrovirals are used. The advent of prolonged Highly Active Anti-Retroviral Therapies (HAARTs) has led to a decline in the incidence of most opportunistic conditions, infections and tumors (except for multiple oral warts and zoster). HAARTs also provoke adverse reactions such as lipodystrophy syndromes (signs of peripheral atrophy and central hypertrophy, associated in varying degrees with metabolic syndromes). Extended survival and the new methods for prophylaxis of opportunistic infections have gradually modified diagnostic and therapeutic strategies for oral manifestations of HIV infections.

Socio-Demographic Factors and Epidemiological Characteristics of HIV-Positive Pregnant Women with High Risk of Vertical Transmission of the Immunodeficiency Virus

The purpose of this study was to determine the features of the course of pregnancy, delivery, and the postpartum period in HIV-positive women with a high risk of HIV vertical transmission. Methods and Results: A retrospective, longitudinal cohort study of mother-child pairs for the period from 2017 to 2019 was conducted in the Irkutsk City Perinatal Center (level III). The clinical observation group included HIV-positive women (n=213) and their newborn children with a high risk of perinatal immunodeficiency virus transmission (n=214). The findings of the conducted study demonstrated that most HIV-seropositive women with a high risk of HIV vertical transmission had an aggravated social history, a high prevalence of pelvic inflammatory diseases, and a high incidence of opportunistic and AIDS-defining conditions. Evaluation of PMTCT preventive complex showed that the target parameters in women with a high risk of HIV transmission were not reached: the first stage was performed for 49.3% of pregnant women with good ART adherence, the second stage – for 97.1% of obstetric patients, the third stage – in 100% of HIV perinatally exposed children. HIV RNA was detected in 3.7% of children, which evidences their antenatal infection. Conclusion: Development of efficient communication with HIV-positive women aimed at preservation of their health and decrease of logistic barriers to access to medical care.

Temperature and place associations with Inuit mental health in the context of climate change

BackgroundClimate change has important implications for mental health globally. Yet, few studies have quantified the magnitude and direction of associations between weather and mental health-related factors, or assessed the geographical distribution of associations, particularly in areas experiencing rapid climatic change. This study examined the associations between air temperature variables and mental health-related community clinic visits across Nunatsiavut, Labrador, Canada, and the place-specific attributes of these associations. MethodsDaily de-identified community clinic visit data were collected from the provincial electronic health recording system and linked to historical weather data (2012–2018). A multilevel, multivariable negative binomial regression model was fit to investigate associations between temperature variables and mental health-related community clinic visits across the region, adjusting for seasonality as a fixed effect and community as a random effect. A multivariable negative binomial model was then fit for each Nunatsiavut community, adjusting for seasonality. ResultsMental health-related visits contributed to 2.4% of all 228,104 visit types across the study period; this proportion ranged from 0.6% to 11.3% based on community and year. Regionally, the incidence rate of mental health-related community clinic visits was greater after two weeks of warm average (i.e. above -5ᵒC) temperatures compared to temperatures below -5ᵒC (IRR-5≤5ᵒC = 1.47, 95% CI = 1.21–1.78; IRR6≤15ᵒC = 2.24, 95% CI = 1.66–3.03; IRR>15ᵒC = 1.73, 95% CI = 1.02–2.94), and the incidence rate of mental health-related clinic visits was lower when the number of consecutive days within −5 to 5ᵒC ranges (i.e. temperatures considered to be critical to land use) increased (IRR = 0.96; 95% CI = 0.94–0.99), adjusting for seasonal and community effects. Community-specific models, however, revealed that no two communities had the same association between meteorological conditions and the incidence rate of daily mental health-related visits. DiscussionRegionally, longer periods of warm temperatures may burden existing healthcare resources and shorter periods of temperatures critical to land use (i.e. −5 to 5ᵒC) may present enjoyable or opportunistic conditions to access community and land-based resources. The heterogeneity found in temperature and mental health-related clinic visits associations across Nunatsiavut communities demonstrates that place quantitatively matters in the context of Inuit mental health and climate change. This evidence underscores the importance of place-based approaches to health policy, planning, adaptation, and research related to climate change, particularly in circumpolar regions such as Nunatsiavut where the rate of warming is one of the fastest on the planet.

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

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

&lt;i&gt;Candida&lt;/i&gt;, the Opportunistic Human Pathogen

Candida species are known human pathogens that have caused high morbidity and mortality among affected individuals. Candida albicans can switch forms from yeast to hyphae, in which both forms are virulent. Due to its commensal status in normal human microflora, C. albicans poses a virtual threat to humankind because of their dimorphism ability under opportunistic environmental conditions. Because of the increased usage of prophylactic antifungal agents in the treatment of candidiasis, reports of Candida species developing antifungal resistance are increasing. Recent observations of cross-reaction between different classes of antifungal drugs that could yield multidrug-resistant pathogenic Candida species are concerns that need to be urgently addressed.

Sulfonamide Inhibition Profile of the β-Carbonic Anhydrase from Malassezia restricta, An Opportunistic Pathogen Triggering Scalp Conditions.

The critical CO2 hydration reaction to bicarbonate and protons is catalyzed by carbonic anhydrases (CAs, EC 4.2.1.1). Their physiological role is to assist the transport of the CO2 and HCO3− at the cellular level, which will not be ensured by the low velocity of the uncatalyzed reaction. CA inhibition may impair the growth of microorganisms. In the yeasts, Candida albicans and Malassezia globosa, the activity of the unique β-CA identified in their genomes was demonstrated to be essential for growth of the pathogen. Here, we decided to investigate the sulfonamide inhibition profile of the homologous β-CA (MreCA) identified in the genome of Malassezia restricta, an opportunistic pathogen triggering dandruff and seborrheic dermatitis. Among 40 investigated derivatives, the best MreCA sulfonamide inhibitors were dorzolamide, brinzolamide, indisulam, valdecoxib, sulthiam, and acetazolamide (KI < 1.0 μM). The MreCA inhibition profile was different from those of the homologous enzyme from Malassezia globosa (MgCA) and the human isoenzymes (hCA I and hCA II). These results might be useful to for designing CA inhibitor scaffolds that may selectively inhibit the dandruff-producing fungi.

Anti-Microbial Effect of Aloe vera Extract on Clotrimazole-Resistant Malassezia Furfur Strains Isolated From Patients with Seborrheic Dermatitis in the City of Sari

Background: Malassezia is a dimorphic and lipophilic fungus that causes skin diseases in opportunistic conditions. Objectives: The aim of the present study was to investigate the antimicrobial activity of Aloe vera extract on growth of clotrimazole-resistant Malassezia furfur isolated from patients with seborrheic dermatitis. Methods: In this descriptive cross-sectional study, 102 samples were selected from skin lesions of suspected cases of seborrheic dermatitis. Malassezia isolates were identified by biochemical tests. To determine drug sensitivity, the broth microdilution method was used. After preparation of Aloe vera extract, the antifungal effect of different concentrations of this extract on clotrimazole-resistant isolates was determined by uing the agar well diffusion method, and its minimum inhibitory concentration (MIC) was evaluated by the broth microdilution method. Results: In this study, 72 strains of Malassezia were isolated, out of which the highest frequency belonged to Malassezia furfur with a frequency of 56 (77.8%) cases, while 50% of them were resistant to clotrimazole. Upon evaluation of antifungal effects of Aloe vera extract, the maximum inhibition zone diameter was seen for the extract in the concentration of 250 mg/mL. This parameter was observed for yeast isolates resistant to clotrimazole at the mean of 25 mm. Changes to the MIC of Aloe vera extract in the range of 1024 - 2 μL/mL showed that 89% of Malassezia furfur isolates resistant to clotrimazole did not grow in concentrations with MIC ≥ 512 μL/mL (P < 0.001). Conclusions: According to our results, Aloe vera extract showed proper inhibitory effects against clinical clotrimazole-resistant Malassezia furfur isolates at high concentrations. Therefore, we could hope to treat fungal diseases by producing an appropriate herbal medicine.

Draft Genome Sequence of Propionibacterium acnes subsp. elongatum Strain Asn12.

Propionibacterium acnes, a non-spore-forming anaerobic Gram-positive bacterium, has been linked to a wide range of opportunistic human infections and conditions, most notably acne vulgaris. Here, we present the draft genome sequence of P. acnes subsp. elongatum strain Asn12, isolated from spinal disc tissue (in the United Kingdom).

KIDNEY LESIONS IN HIV PATIENTS. IATROGENIC LESIONS AND THEIR DIAGNOSTICS AND TREATMENT. Part 2

Drug-induces and other iatrogenic lesions of kidney in HIV patients are inevitable upon ART and a therapy for the main opportunistic and concomitant conditions. Besides the direct effects of HIV, the side effects of drugs, such as acute renal lesions, crystal nephropathy, glomerulonephritis, acute and chronic renal failure, and functional renal impairments, are associated with poor ART efficacy and unfavorable prognosis and outcome. In the present paper, the morphological and clinical manifestations of ART-induced renal lesions are described. The main approaches to the early diagnostics of and screening for kidney lesions are suggested. The significance of the most prevalent functional and clinical renal disorders routinely encountered by physicians is evaluated.

The Therapist’s Needs: Beyond Mutual Recognition

As early as 1965, Harold Searles argued that therapists’ needs for healing and growth are part and parcel of their work with patients. Since then, the relational movement has corroborated this idea by articulating the healing function of treatment for both patient and clinician. In this article, the authors examine therapists’ needs that have been overlooked or those that have not been considered fully in the literature. Using various ideas related to the concept of what the authors call therapeutic freedom, this article argues that clinicians must strive to adopt a therapeutic vision that aims to loosen their own ties to safe, familiar modes of engaging with patients, particularly in moments of enactment or impasse. The authors elucidate these ideas with case material from their clinical work and show how embracing various forms of therapeutic freedom results in a type of mutual surrender on the part of both patient and therapist, creating opportunistic conditions that generate therapeutic action and new possibilities for the dyad.

Characterization by PCR-RFLP of the Cryptococcus neoformans and Cryptococcus gattii species complex in Venezuela

Abstract. Cryptococcosis is a sub-acute or chronic mycosis caused by opportunistic yeasts of the Cryptococcus genus, mainly by the C. neoformans and C.gattii species complex. This disease tends to position itself as one of the first opportunistic conditions associated with AIDS, with a high morbidity in these patients, who frequently develop meningoencephalitis. To date, there are techniques that allow the identification of the eight molecular types associated with these species complex, but there is little information about their circulation in Venezuela. The purpose of this work was to perform the molecular characterization of the C. neoformans and C.gattii species complex by PCR-RFLP. A total of 80 strains were used, 65 of the C. neoformans complex (CNC) and 15 of the C. gattii complex (CGC), following the protocol described by Escandon et al., carrying out the amplification of the URA5 gene and subsequent digestion with the Sau96I and HhaI restriction enzymes, that generated band patterns that allowed the identification of different molecular types. The most prevalent molecular type was VNI with 68.75% (n=55), similar to that reported worldwide;secondly, VGII molecular type with con 15% (n=12), which corresponds to that reported for Latin America, followed by VNII with 11.25% (n=9), VGIII with 2.5% (n=2), VNIII with 1.25% (n=1) and VGI with 1.25% (n=1)). Ninety-two point three percent of CCN (n=60) and 66.7% (n=10) of GCC isolates were from patients with HIV/AIDS. This study provided important epidemiological information on circulating molecular types and allowed to deepen the knowledge of this opportunistic mycosis in Venezuela.

People living with AIDS, management in hospitalization in decentralized area in Senegal, example of the town of Thies

Objectives: Our objective was to describe the socio-demographic, clinical, para-clinical, therapeutic and evolutionary characteristics of PHAs hospitalized at the Regional Hospital of Thiès.Patients and methods:This is a retrospective descriptive study from the files of patients hospitalized at the regional hospital of Thiès from 1 January 2010 to 31 December 2015. The data were entered and analyzed using Epi info 3.5.4.Results:We have collected 101 positive HIV patients. The sex ratio M / F was 0.56 and the average age of patients 43 years ± 10.5 with extremes of 15 and 78 years. Almost all of our patients resided in the region of Thiès (82.3%).In the majority of cases, the serological status of the patients was known before hospitalization (78.2%) and 71.9% of patients were in severe immunosuppression (CD4 &lt;200 / mm3). Slightly more than half, or 53.5%, were already on HAART before admission.The main causes of hospitalization found in our patients were opportunistic infections, mainly tuberculosis, which was also the leading cause of death. Other causes of hospitalization were cerebral toxoplasmosis (9 cases), candidiasis (3 cases). Undernutrition was found in more than 50% of cases. The mean hospital stay was 15 days ± 9. Approximately two-thirds of patients (60.3%) had a hospital stay of less than 15 days.Conclusion: In Senegal, the effective decentralization of the care of PHAs in the health districts of the country is effective. However, it should be stressed that opportunistic infections and conditions are still frequent causes of hospitalization and lead to significant morbidity and mortality.Key Words: HIV Patient, Hospitalization, Thies

Profile of Anaemia in HIV Positive Patients

Background &amp; Objectives: This was a cross-sectional observational study designed to see the prevalence of anemia among HIV positive patients and its correlation with CD4 counts.Materials &amp; Methods: Fifty five HIV/AIDS patients presented for the first time to Tribhuwan University Teaching Hospital [TUTH] were enrolled in the study. Patients' duration of HIV positivity, history regarding ART and duration, history of associated co morbid or opportunistic conditions were taken, CD4 counts, RFT, CBC test results were recorded. Patients' clinical and laboratory parameters were recorded. Anaemia was classified by WHO criteria for both men and women.Results: Out of 55 patients, 23 (42 %) had anemia, out of which 14 (60.87 %) had mild anemia (anemia but Hb not less than 9.5g/dl), four (17.39%) had moderate anemia (Hb 8 to 9.4 g/ dL) and two (8.7%) had severe anemia (Hb 6.5 to 7.9 g/dL) and three (13.04%) had very severe or life threatening anemia (Hb less than 6.5 g/dL). Corresponding odds ratio from stage CD4 counts&lt;200 to CD4 counts &gt;/= 200 for anemia was 4.55 times; which is statistically significant (p&lt;0.0001). There was negative association between the prevalence of anemia and HIV stage (CD4 count).Conclusion: There was high prevalence of anemia and severity of immunodeficiency directly correlates with degree of anemia. Degree of anemia can be easily assessed even in rural clinical setting, hence degree of immunodeficiency can early be detected in all settings.JCMS Nepal. 2016;12(2):70-3

Clinical presentation, causes and outcome of febrile episodes in a prospective cohort of HIV-infected patients

Background: Fever was frequently caused by opportunistic conditions in HIV-patients in the early years of the epidemic. Little is known about diagnostic spectrum and outcome of febrile episodes in patients with good access to antiretroviral therapy.Methods: We prospectively studied clinical presentation, diagnosis and outcome of febrile episodes in a contemporary cohort of HIV-patients with good access to antiretroviral therapy. Fever was defined as temperature 38.3 °C or higher, measured by a health care provider.Results: We found 220 febrile episodes in 146 patients. In 25.9% of episodes the patient had a CD4 less than 200/mm³ and in 78.6% the patient was on antiretroviral therapy. There were multiple episodes in 44 patients. A diagnosis was established in 91.8%. Infection accounted for 82.3%, mainly respiratory tract infections, viral syndromes and abdominal infections. Malignancy, drug reactions and inflammatory conditions accounted together for less than 12% of episodes. Fifteen percent were attributed to opportunistic conditions. Episodes in patients with CD4 less than 200 were less likely to be caused by infection, but more likely to be caused by malignancy, drug reactions and opportunistic conditions. In 6.4% the patient died within six months after the onset of fever. Risk factors for death at six months in multivariable analysis were higher age and lower CD4.Conclusions: HIV-patients with access to antiretroviral therapy present with fever mostly due to conditions common in the general population. HIV-patients with low CD4 remain at risk for fever due to opportunistic conditions and death.