Diagnosis Of Opportunistic Infections Research Articles

High Serum Ferritin Level to Predict the Severity of Dengue Viral Infection

This study aims to identify common opportunistic infections and their prevalence among people living with HIV in Osogbo, Osun state, who are receiving treatments for the HIV virus, which has spread widely.A mixed study design was employed, including a hospital-based retrospective study and a Key Informant Interview. The retrospective study involved 280 HIV patients at State Specialists Hospital Asubiaro SSHA Osogbo, Nigeria, and collected socio-demographic, opportunistic infection diagnosis, and viral load test results. The study also included a Key Informant Interview with six health workers in the HIV care unit. Quantitative data was analyzed using descriptive statistics and Chi-square tests, while qualitative data was analyzed using a thematic approach.The study reveals that the majority of People Living with HIV are females (77.1%), with 69% unemployed and 28.6% employed. Most are married (82.5%). In 2020, 58.2% achieved viral suppression, while in 2021, 65.7% and 69% achieved it. Common opportunistic infections include tuberculosis, pruritus, oral candidiasis, and herpes zoster. The prevalence of opportunistic infections decreased from 9.0% to 7.6% between January 2020 and May 2022.The prevalence of opportunistic infections in the study was low, which is due to the high preventive measures employed by the health workers in the hospital. Hence adherence to HAART (Highly Active Antiretroviral Therapy) medications helps to maintain healthy living for People living with HIV

Prevalence Of Opportunistic Infections Among People Living With HIV In Osogbo, Osun State

This study aims to identify common opportunistic infections and their prevalence among people living with HIV in Osogbo, Osun state, who are receiving treatments for the HIV virus, which has spread widely. A mixed study design was employed, including a hospital-based retrospective study and a Key Informant Interview. The retrospective study involved 280 HIV patients at State Specialists Hospital Asubiaro SSHA Osogbo, Nigeria, and collected socio-demographic, opportunistic infection diagnosis, and viral load test results. The study also included a Key Informant Interview with six health workers in the HIV care unit. Quantitative data was analyzed using descriptive statistics and Chi-square tests, while qualitative data was analyzed using a thematic approach. The study reveals that the majority of People Living with HIV are females (77.1%), with 69% unemployed and 28.6% employed. Most are married (82.5%). In 2020, 58.2% achieved viral suppression, while in 2021, 65.7% and 69% achieved it. Common opportunistic infections include tuberculosis, pruritus, oral candidiasis, and herpes zoster. The prevalence of opportunistic infections decreased from 9.0% to 7.6% between January 2020 and May 2022. The prevalence of opportunistic infections in the study was low, which is due to the high preventive measures employed by the health workers in the hospital. Hence adherence to HAART (Highly Active Antiretroviral Therapy) medications helps to maintain healthy living for People living with HIV

Blood biomarkers for HIV infection with focus on neurologic complications-A review.

Although clinical examinations, neuroimaging, and cerebrospinal fluid analyses are the most important ways to evaluate the impact of HIV infection on the brain and in diagnosis of opportunistic infections, several blood biomarkers including HIV RNA concentrations, CD4 +T‐cell count, and neurofilament light chain protein (NfL) concentration, along with tests for opportunistic infections can provide important information for clinical decisions.

X-RAY-morphological features of the current COVID-19 and HIV infection

Infection of HIV-infected with a new coronavirus infection, due to its high contagiousness, is inevitably growing all over the world. According to estimates of Chinese scientists, their number is currently more than 500 thousand people. Considering that COVID-19 leads to suppression of immunity and the emergence of opportunistic infections in HIV-negative patients, the activation of secondary diseases in patients with HIV is natural. In view of this, the study of the features of the X-ray morphological picture of inflammatory changes in the lungs according to MSCT data in patients with COVID-19/HIV became the goal of this study. 13 patients who underwent treatment at the Surgut Regional Clinical Hospital during the period from March to July 2020 underwent MSCT of the chest organs upon admission, before discharge, as well as in case of deterioration or lack of effect from the therapy — every 3 days. The detection of pathognomonic CT signs of COVID-19 in the lungs in patients with HIV (the nature of the lesion, the stage of the disease, the severity of the inflammatory process) was carried out in parallel with the diagnosis of opportunistic infections. During the examination, atypical clinical and X-ray morphological signs of the course of COVID-19/HIV coinfection were identified. In HIV-infected people, COVID-19 proceeds more easily and in disguise, while opportunistic infections both in clinical and radiological manifestations have priority signs. They are the reasons for the aggravation of the course of the disease, as well as the development of complications in these patients.

Some Opportunistic Infections in Childhood: Causes, Diagnosis and Treatment Methods

The article discusses the features of the emergence and development of the so-called opportunistic infections that occur in children with weakened immunity.
 Such infections are often caused by non-tuberculosis mycobacteria, fungi, and herpesviruses, and such infections can also develop in children who are treated with immunobiological drugs. Since these are serious and rapidly developing diseases, the diagnosis should be made at the earliest stages of the development of the disease and be based on the features of clinical phenomena described in the literature and anamnesis data indicating the presence of such infections. The earlier an infection is detected, the faster it will be possible to start appropriate therapy.
 The relevance of this topic is due to the fact that, despite the improvement in the diagnosis of opportunistic infections in recent years, they still are a problem for pediatricians, who are not always able to diagnose them in time. Accordingly, the pediatrician should, in case of suspicion of the presence of such an infection in a child patient, contact specialists who have experience in their treatment in order to take timely measures to stop the development of the disease.
 The aim of the study is to consider the features of some opportunistic infections in childhood, their causes, diagnosis, and treatment methods.

Non-Hodgkin Lymphoma: A Risk Factor for in-Hospital Mortality in Patients Hospitalized with Opportunistic Infections

Background Opportunistic infections (OI's) are defined as infections that are more frequent or more severe because of immunosuppression. Conditions like HIV infections, Hematopoietic stem cell transplantation and autoimmune diseases have been established as risk factors for increased mortality in OI. Studies suggest that lymphomas are a risk factor for mortality associated with OI's like Tuberculosis and candida probably due to underlying immunodeficiency and therapeutic exposures inducing prolonged lymphopenia. Data describing association of underlying Non-Hodgkin Lymphoma (NHL) on mortality associated with OI's is limited. Our objective was to study impact of NHL on in‐hospital mortality of patients hospitalized with OI's. Methods We analyzed data from the Healthcare Cost and Utilization Project's (HCUP) National Inpatient Sample, between 2010 and 2014 using the ICD-9 codes for Opportunistic infections (OI). The subset of this cohort with NHL excluding lymphoid leukemias listed as a secondary diagnosis were included for analysis. Baseline characteristics including age, race, gender, Charlson comorbidity index, and infection with HIV etc. were analyzed for patients with admitted with OI's, with and without underlying diagnosis of NHL. Our primary outcome was in-hospital mortality. Characteristics associated with in‐hospital mortality were identified using multivariable logistic regression. Results Between 2010 and 2014, a total of 181,016 admissions were identified with a primary diagnosis of OI. Amongst these, 4442 admissions had an underlying diagnosis of NHL. Mean age of patients hospitalized with OI's with NHL, was higher (65.4 ±0.52 years vs 58.9±0.14years, p Conclusion OI's constitute a major cause of morbidity and mortality in immunocompromised patients. There is limited data from a nationwide analysis which evaluates association of opportunistic infections and lymphoma as risk factor of mortality. Our study suggests that NHL is an independent risk factor for mortality in patients who were admitted in the hospital for OI's. Further studies should be considered to the role of primary prophylaxis for conditions like PCP to avoid morbidity and mortality associated with these conditions. This will help reduce health care cost burden associated with such hospitalizations.

Opportunistic Infections, Is Non Hodgkin Lymphoma One of the Risk Factors for Mortality?

Background:Opportunistic infections (OI's) are defined as infections that are more frequent or more severe because of immunosuppression. Conditions like HIV infections, Hematopoietic stem cell transplantation, autoimmune diseases like SLE and RA have been established as risk factors for increased mortality in OI. Studies suggest that lymphomas are a risk factor for mortality associated with OI's like Tuberculosis and candida (Silva et al, 2005; Chen et al, 2014) probably due to underlying immunodeficiency and therapeutic exposures inducing prolonged lymphopenia. Data describing association of underlying Non-Hodgkin Lymphoma (NHL) on mortality associated with OI's is limited. Our objective was to study impact of NHL on in‐hospital mortality of patients hospitalized with OI's.Methods:We analyzed data from the Healthcare Cost and Utilization Project's (HCUP) National Inpatient Sample, between 2010 and 2014 using the ICD-9 codes for Opportunistic infections (OI) which included tuberculosis (010-018), non-tubercular mycobacteria (031), cytomegalovirus (078.5), Herpes Zoster( 053), Candidiasis(112.4), Toxoplasmosis (130), Pneumocystis (136.3), Cryptococcosis(117.5), Listerosis (027.0), Nocardiosis (039), Aspergillosis (117.3) coccidiomycosis (114), histoplasmosis (115), blastomycosis (116.0) . The subset of this cohort with NHL excluding lymphoid leukemias listed as a secondary diagnosis were collected for analysis. Baseline characteristics including age, race, gender, Charlson comorbidity index, and infection with HIV etc. were analyzed for patients with admitted with OI's, with and without underlying diagnosis of NHL. Our primary outcome was in-hospital mortality. Characteristics associated with in‐hospital mortality were identified using multivariable logistic regression.ResultsBetween 2010 and 2014, a total of 1,81,016 admissions were identified with a primary diagnosis of OI. A total of 4442 admissions had an underlying diagnosis of NHL. Mean age of patients hospitalized with OI's with NHL, was higher (65.4 ±0.52 years vs 58.9±0.14years, p<0.05 ), and 54.7% of the patients were males. Racial distribution of the patients with NHL was similar to those suggested in previous studies (Li et sl, 2016), with 73.19% patients being whites. Patient's median income, hospital bed-size and teaching status of hospital all were found to be significant risk factors (p<0.05) for mortality. When adjusted for the above mentioned factors, as well as HIV or Transplant status of patients, NHL was found to be an independent factor for mortality with an odds ratio of 1.34 (p=0.03).ConclusionOI's constitute a major cause of morbidity and mortality in immunocompromised patients. There is limited data from a nationwide analysis which evaluates association of opportunistic infections and lymphoma as an independent marker of mortality. Our study suggests that NHL is an independent risk factor for mortality in patients who were admitted in the hospital for OI's. Further studies should be considered to the role of primary prophylaxis for conditions like PCP to avoid morbidity and mortality associated with these conditions. This will help reduce health care cost burden associated with such hospitalizations. DisclosuresNo relevant conflicts of interest to declare.

Prevalence of anemia and its associated factors in human immuno deficiency virus infected adult individuals in Ethiopia. A systematic review and meta-analysis

BackgroundAnemia is a common hematologic disorder among human Immunodeficiency virus (HIV) infected adult Individuals. However, there is no concrete scientific evidence established at national level in Ethiopia. Hence, this review gave special emphasis on Ethiopian HIV infected adult individuals to estimate pooled prevalence of anemia and its associated factors at national level.MethodsStudies were retrieved through search engines in PUBMED/Medline, Cochrane Library, and the web of science, Google and Google scholar following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Joanna Briggs Institute Meta-Analysis of Statistical Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of the included studies. Random effects meta-analysis was used to estimate the pooled prevalence of anemia and associated factors at 95% Confidence interval with its respective odds ratio (OR). Meta regression was also carried out to identify the factors. Moreover, Sub-group analysis, begs and egger test followed by trim-and-fill analysis were employed to assess heterogeneity and publication bias respectively.ResultA total of 532 articles were identified through searching of which 20 studies were included in the final review with a total sample size of 8079 HIV infected adult individuals. The pooled prevalence of anemia was 31.00% (95% CI: 23.94, 38.02). Cluster of Differentiation 4 (CD4) count <= 200 cells/μl with OR = 3.01 (95% CI: 1.87, 4.84), World Health Organization (WHO) clinical stage III&IV with OR = 2.5 (95% CI: 1.29, 4.84), opportunistic infections (OIs) with OR = 1.76 (95% CI: 1.07, 2.89) and body mass index (BMI) < 18.5 kg/M2 with OR = 1.55 ((95% CI: 1. 28, 1.88) were the associated factors.ConclusionThis review demonstrates high prevalence of anemia among HIV infected adults. Low CD4 count, WHO clinical stage III&IV, OIs and low level of BMI were found to have significant association with the occurrence of anemia. Therefore, the responsible stockholders including anti retro viral treatment (ART) clinics should strengthen the system and procedures for the early diagnosis of opportunistic infection and screening of underlying problems. There should be also early screening for OIs and under nutrition with strict and frequent monitoring of HIV infected individuals CD4 count.

Diagnosis of opportunistic infections: HIV co-infections - tuberculosis.

Tuberculosis (TB) incidence has declined ∼1.5% annually since 2000, but continued to affect 10.4 million individuals in 2015, with 1/3 remaining undiagnosed or underreported. The diagnosis of TB among those co-infected with HIV is challenging as TB remains the leading cause of death in such individuals. Accurate and rapid diagnosis of active TB will avert mortality in both adults and children, reduce transmission, and assist in timeous decisions for antiretroviral therapy initiation. This review describes advances in diagnosing TB, especially among HIV co-infected individuals, highlights national program's uptake, and impact on patient care. The TB diagnostic landscape has been transformed over the last 5 years. Molecular diagnostics such as Xpert MTB/RIF, which simultaneously detects Mycobacterium tuberculosis (MTB) resistance to rifampicin, has revolutionized TB control programs. WHO endorsed the use of Xpert MTB/RIF in 2010 for use in HIV/TB co-infected patients, and later in 2013 for use as the initial diagnostic test for all adults and children with signs and symptoms of pulmonary TB. Line probe assays (LPAs) are recommended for the detection of rifampicin and isoniazid resistance in sputum smear-positive specimens and mycobacterial cultures. A second-line line probe assay has been recommended for the diagnosis of extensively drug-resistant (XDR)-TB Assays such as the urine lateral flow (LF)-lipoarabinomannan (LAM), can be used at the point of care (POC) and have a niche role to supplement the diagnosis of TB in seriously ill HIV-infected, hospitalized patients with low CD4 cell counts of less than 100 cells/μl. Polyvalent platforms such as the m2000 (Abbott Molecular) and GeneXpert (Cepheid) offer potential for integration of HIV and TB testing services. While the Research and Development (R&D) pipeline appears to be rich at first glance, there are actually few leads for true POC tests that would allow for earlier TB diagnosis or rapid, comprehensive drug susceptibility testing, especially when considering the very high attrition rates observed between biomarker discovery and product market entry. In this review, we describe diagnostic strategies specifically for HIV and TB co-infected individuals. Molecular diagnostics in particular within the past 5 years have revolutionized and 'disrupted' this field. They lend themselves to integration of services with platforms capable of polyvalent testing. Impact on patient care is, however, still debatable. What has been highlighted is the need for health system strengthening and for true POC testing that can be used in active case finding.

Opportunistic Infections among People Living with HIV (PLHIV) with Diabetes Mellitus (DM) Attending a Tertiary Care Hospital in Coastal City of South India.

BackgroundHIV/AIDS and Diabetes Mellitus are the diseases’ known to supress cell mediated immunity and predispose patients for opportunistic infections. Hence, we conducted a study to compare the common opportunistic infections (OIs) between People Living with HIV with DM (PLHIV-DM) and PLHIV without DM (PLHIV).MethodologyPLHIV with DM and without DM (1:1) were prospectively included in the study from January 2011 to January 2012 at a tertiary care hospital in Mangalore city. Patients were classified as Diabetic if their fasting plasma glucose was ≥ 7.0mmol/l (126mg/dl) or 2–h plasma glucose was ≥11.1mmol/l (200mg/dl). Standard procedures and techniques were followed for diagnosis of OIs as per WHO guidelines. The data was entered and analyzed using Statistical Package for Social Sciences (SPSS) version 11.5.FindingsThe study included 37 PLHIV with DM and 37 PLHIV without DM and both groups were treated with Anti-Retroviral Therapy (ART). The median age was 47 years (IQR: 41-55years) for PLHIV-DM as compared to 40 years (IQR: 35–45.5 years) for PLHIV (p<0.0001). PLHIV-DM had median CD4 counts of 245 (IQR: 148–348) cells/μl compared to 150(IQR: 70–278) cells/μl for PLHIV (p = 0.02). Common OIs included oral candidiasis (49% of PLHIV-DM and 35% of PLHIV); Cryptococcal meningitis (19% of PLHIV-DM and 16% of PLHIV); Pneumocystis jiroveci pneumonia (5% of PLHIV-DM and 18% of PLHIV); extra pulmonary tuberculosis (22% of PLHIV-DM and 34.5% of PLHIV); and Cerebral toxoplasmosis (11% of PLHIV–DM and 13.5% of PLHIV). Microbiological testing of samples from PLHIV- DM, C krusei was the most common Candida species isolated from 9 out of 18 samples. Out of six pulmonary TB samples cultured, four grew Non-tuberculosis mycobacteria (NTM) and two Mycobacterium tuberculosis complexes.ConclusionsStudy did not identify any significant difference in profile of opportunistic infections (OIs) between PLHIV with and without Diabetes.

Clinical and Immunologic Predictors of Death After an Acute Opportunistic Infection: Results from ACTG A5164

Background: In the pre–antiretroviral therapy (ART) era, markers of increased disease severity during an acute opportunistic infection (OI) were associated with mortality. Even with ART, mortality remains high during the first year after an OI in persons with advanced HIV infection, but it is unclear whether previous predictors of mortality remain valid in the current era. Objective: To determine clinical and immunological predictors of death after an OI. Methods: We used clinical data and stored plasma from ACTG A5164, a multicenter study evaluating the optimal timing of ART during a nontuberculous OI. We developed Cox models evaluating associations between clinical parameters and plasma marker levels at entry and time to death over the first 48 weeks after the diagnosis of OI. We developed multivariable models incorporating only clinical parameters, only plasma marker levels, or both. Results: The median CD4+ T-cell count in study participants at baseline was 29 cells/µL. Sixty-four percent of subjects had Pneumocystis jirovecii pneumonia (PCP). Twenty-three of 282 (8.2%) subjects died. In univariate analyses, entry mycobacterial infection, OI number, hospitalization, low albumin, low hemoglobin, lower CD4, and higher IL-8 and sTNFrII levels and lower IL-17 levels were associated with mortality. In the combined model using both clinical and immunologic parameters, the presence of an entry mycobacterial infection and higher sTNFrII levels were significantly associated with death. Conclusions: In the ART era, clinical risk factors for death previously identified in the pre-ART era remain predictive. Additionally, activation of the innate immune system is associated with an increased risk of death following an acute OI.

CMV esophagitis: sequelae of radiation therapy

Cytomegalovirus (CMV) infection has been commonly described in immunocompromised patients. Antiretroviral therapy in HIV patients and routine antiviral prophylaxis in transplant recipients have helped to curb the majority of clinically significant CMV infections. Patients undergoing chemotherapy are also closely monitored for leucopenia and opportunistic infections. We describe here a case of CMV esophagitis in a patient with a solid tumor and no prior exposure to chemotherapy. This patient was immunocompromised from his recent radiation therapy and concurrent steroid use. This case demonstrates the fact that even without any exposure to chemotherapy, extensive radiation treatment can lead to severe marrow suppression. Early endoscopy in such patients is recommended to avoid delay in the diagnosis of opportunistic infections.

Opportunistic infections in Human Immunodeficiency Virus (HIV) infected patients from rural tertiary care hospital of western Maharashtra

Background: The wide ranging clinical manifestations and pathological changes in patients infected with HIV / AIDS are both fascinating and challenging to health care professionals. OIs constitute a major health problem in patients infected with HIV. The type of pathogens responsible for morbidity and mortality vary from country to country and even from region to region within the same country. Objective: This study was designed with an aim to document the trends of opportunistic infections in HIV infected patients from rural tertiary care hospital of Western Maharashtra. Such studies have not been worked out before in this region. Methods: The study included various specimens from 142 HIV infected patients. All specimens were processed as per standard microbiological protocol for demonstration or isolation of pathogens. Results: HIV infection was more in males (62.6%). The most common clinical feature was weight loss (47.8%). Infectious agents were demonstrated or isolated in 81.6% HIV infected patients. Mycobacterium tuberculosis (44.8%) was the most common isolate followed by Candida species (23.2%). Conclusion: Opportunistic infections (OIs) are common complication in HIV infection. They cause substantial morbidity and hospitalization, necessitate toxic and expensive therapies and shorten the survival of people with HIV. Hence the early and accurate diagnosis of OIs is important.

Profile and clinical features of HIV positive patients attending Integrated Counseling and Testing Centre in a Medical College Hospital of Hassan, Karnataka

Background: HIV infection is a major public health problem as it has dramatically increased the global burden of disease. HIV infected patients experience a variety of clinical signs and symptoms. Objective: Our objective was to study the profile of clinical features and opportunistic infections in HIV infected patients attending a tertiary care medical college hospital in Hassan, Karnataka. Materials and Methods: A total of 124 HIV infected patients attending the ART Centre and the ICTC of Hassan Institute of Medical Sciences, Hassan, Karnataka were enrolled in the study, after obtaining informed consent. Clinical symptoms were recorded by direct questioning. Documented opportunistic infections were noted from patient records. Results: 80 (64.5%) HIV positive patients were males and 44 (35.5%) females. Mean age of the patients was 36.5 ± 6.0 years. The common symptoms were lethargy and fatigue 90 (72.5%), prolonged fever 86 (69.3%), weakness 84 (67.7%), body-ache and joint pain 84 (67.7%), loss of appetite 82 (66.1%), weight loss 80 (64.5%), cough (44.5%), chronic diarrhoea 68 (54.8%) and Nausea and Vomiting 64 (51.6%).The overall proportion of symptomatic patients was significantly higher than the number with etiologically documented opportunistic infections (41.9%). Pulmonary tuberculosis (37.9%) was the most frequently documented opportunistic infection. Conclusion: Affordable high quality laboratory diagnostic facilities for the diagnosis of opportunistic infections under the public health program will help to obtain an accurate picture of the range of opportunistic infections in HIV patients in India.

Opportunistic infections in systemic lupus erythematosus

Opportunistic infections (OIs) are not frequently seen in systemic lupus erythematosus (SLE). However, when present they are very dangerous, being potentially fatal in the majority of cases. Immunosuppressive therapy is the strongest risk factor for OI and correlates with death during infective episodes, but there are other factors predisposing to infection in SLE patients, such as several defects of the immune system that are intrinsic to the disease. The diagnosis of OI in SLE may be overlooked, owing to the fact that SLE flares may mimic infection with fever and inflammatory syndrome, and needs special attention in patients at risk. Finally, we have to consider that OIs could be a trigger of SLE too.

1 Introduction

1 Introduction

Study of bone marrow changes in antiretroviral naive human immunodeficiency virus-infected anemic patients

Bone marrow changes are common throughout the course of HIV infection. There is scanty data addressing this issue in Indian subcontinent. The present study was aimed at characterizing the bone marrow changes in the antiretroviral naive HIV-infected Indian patients with anemia. This was a nonrandomized cross-sectional observational study undertaken over a period of 2 years. Forty-six randomly selected patients with documented anemia served as the study population. None of them was on any antiretroviral therapy or suffering from any known causes of anemia. All the patients underwent thorough evaluation, including bone marrow examination. Majority of the patients had normocytic-normochromic anemia (63%), in tune with the available data. In most of the cases bone marrow was hypercellular (63.04%), although in a significant proportion it was found to be hypocellular (19.57%). Erythropoiesis was suppressed in 36.96% of patients. Dysplastic changes involving isolated cell lines ranged from 13.04% to 45.65%, dysmegakaryopoiesis being the most common, followed by dyserythropoiesis. Marrow plasmacytosis was detected in 23.91% of patients. No statistically significant correlation was detected in between immunological status (CD4 count) and marrow cellularity, myelodysplastic changes or marrow plasmacytosis. In a fair number of cases bone marrow examination aided in the diagnosis of opportunistic infections. Bone marrow changes are common in Indian HIV-infected anemic population, particularly in the advanced stages of the disease. HIV infection should be considered in the differential diagnosis of patients with secondary myelodysplasia or unexplained bone marrow changes.

Clinical Staging of HIV-Related Illness in Mozambique: Performance of Nonphysician Clinicians Based on Direct Observation of Clinical Care and Implications for Health Worker Training

In Mozambique, clinical staging may be the primary determinant of HIV/AIDS treatment decisions, and the task of staging commonly falls to nonphysician clinicians (técnicos de medicina). Two years after the first Mozambican técnicos were trained in HIV/AIDS care, the quality of their performance in clinical staging was unknown. Expert clinicians observed 127 clinical encounters conducted by a randomly selected national sample of 44 técnicos and compared observed clinical staging decisions to World Health Organization and Mozambican national norms. They also reviewed relevant Mozambican in-service training curricula in HIV/AIDS care. Observers agreed with fewer than half (44.1%) of the técnicos' stage-defining diagnoses. Misclassification or misdiagnosis of 3 complaints (weight loss, fever, and diarrhea) accounted for the majority of the observed errors. Review of health worker curricula determined that observed staging errors reflected content errors and omissions in the técnicos' in-service HIV/AIDS training and constraints in local laboratory and imaging capacity. In response to these findings, the Mozambican Ministry of Health has revised the técnicos' scope of work and has developed new guidelines, curriculum materials, and training strategies to improve the quality of clinical staging and opportunistic infection diagnosis in Mozambique.

Infecções oportunistas em indivíduos com infecção pelo HIV e relação com uso de terapia antirretroviral

The use of HAART therapy and the spread of primary and secondary prophylaxis led to a reduction in the number of opportunistic infections. The relationship between non-adherence to antiretroviral therapy and the development of resistance of the HIV virus is an established fact. This study evaluated the incidence of opportunistic infections in HIV patients and related them to the regular/irregular use of non-anti-retroviral therapy. Clinical evaluations were made and medical reports and tests consulted to detect opportunistic infections and a questionnaire was applied to evaluate the use of antiretroviral drugs. A questionnaire was applied for socioeconomic and clinical evaluation for the diagnosis of opportunistic infection. We evaluated 144 patients, 131 had opportunistic infections before the HAART therapy and 74 even after HAART therapy with an episode of opportunistic infection in 44 (59.45%) patients where 34 (45.95%) alleged irregular anti – retroviral use and 10 (13.5%), regular use. There were two episodes of opportunistic infections in 26 (35.14%) patients, 21 (28.38%) with irregular use of antiretrovirals and five (6.76%) with regular use and three episodes of opportunistic infections in four patients (5, 41%), three (4.05%) with irregular use of therapy and one (1.35%) with regular use. As is observed in other regions of Brazil, the incidence of opportunistic infections decreased with the use of HAART therapy. On the other hand, there continue to be new cases of opportunistic infections, suggesting that some people have exhausted all possibilities as to available therapies.

Bone marrow biopsy in the diagnoses of infectious and non-infectious causes in patients with advanced HIV infection

Fever and peripheral blood abnormalities in patients with advanced acquired immunodeficiency syndrome are usually due to disseminated opportunistic infections. The objective of this study was to evaluate the diagnostic yield of histopathological and microbiological investigations of bone marrow samples from HIV-infected patients with fever and/or cytopenias. The diagnostic utility of bone marrow aspiration, biopsy and culture was retrospectively examined in 82 patients with HIV/AIDS (median CD4 count 51 microL(-1), range 1-430 microL(-1)) with peripheral cytopenias and/or fever attended at a large tertiary care hospital in Brazil during a one-year period. The diagnostic yield of bone marrow biopsy was 34.1% (28 cases) in contrast to only 8.5% (eight cases) attained by the bone marrow smear. Opportunistic pathogens were isolated from bone marrow cultures in 26.8% of patients. Bone marrow biopsy has value in diagnosis of opportunistic infections, malignancies or other conditions in one-third of adult patients with advanced AIDS and fever or cytopenias and should be considered in this patient group.