Opportunistic Infections In HIV Patients Research Articles

Protocol for the systematic review of the Pneumocystis jirovecii-associated pneumonia in non-HIV immunocompromised patients.

Pneumocystis jirovecii pneumonia (PJP) is a well-known and frequent opportunistic infection in HIV patients. However, there has been an increase in the number of reports of PJP in other immunosuppressed patients with autoimmune inflammatory disorders or because of chemotherapy and high doses of steroids, especially when used in combination as part of immunosuppressive therapy. Despite the increasing importance of PJP in non-HIV patients, there is a lack of comprehensive and updated information on the epidemiology, pathogenesis, diagnosis, microbiology, treatments, and prophylaxis of this infection in this population. Therefore, the objective of this systematic review is to synthesize information on these aspects, from a perspective of evidence-based medicine. The protocol is prepared following the preferred reporting items for systematic reviews and meta-analyses (PRISMA-P) guidelines. We will perform a systematic review of literature published between January 2010 and July 2023, using the databases PubMed, Google Scholar, ScienceDirect, and Web of Science. In addition, manual searches will be carried out through related articles, and references to included articles. The main findings and clinical outcomes were extracted from all the eligible studies with a standardized instrument. Two authors will independently screen titles and abstracts, review full texts, and collect data. Disagreements will be resolved by discussion, and a third reviewer will decide if there is no consensus. We will synthesize the results using a narrative or a meta-analytic approach, depending on the heterogeneity of the studies. It is expected that this systematic review will provide a comprehensive and up-to-date overview of the state-of-the-art of PJP in non-HIV patients. Furthermore, the study will highlight possible gaps in knowledge that should be addressed through new research. Here, we present the protocol for a systematic review which will consider all existing evidence from peer-reviewed publication sources relevant to the primary and secondary outcomes related to diagnosing and managing PJP in non-HIV patients.

Incidence of Opportunistic Infections in HIV Patients at Anti-Retroviral Therapy (ART) Adherence Unit, Islamabad Pakistan

Background: Opportunistic infections (OIs) pose a considerable threat to HIV-infected individuals, especially in regions with varied environmental exposures and healthcare resources. The prevalence and severity of these infections are influenced by factors such as local pathogen profiles, host genetics, and the effectiveness of antiretroviral therapy (ART). Objective: This study aimed to determine the prevalence and types of opportunistic infections among male HIV-positive patients at an ART adherence unit in Islamabad, Pakistan, and to compare these with regional trends. Methods: An institution-based cross-sectional study design was utilized, encompassing a review of medical records from 533 male HIV-positive patients over a seven-month period. Data collection focused on demographic details, infection types, and treatment regimens. Exclusion criteria included incomplete files and unspecified OIs. The analysis was performed using SPSS version 25, with frequencies and percentages calculated to assess the prevalence of each infection type. Results: Out of 533 patients, 149 (27.95%) developed at least one opportunistic infection. Respiratory infections were most common, with tuberculosis (TB) found in 25 (16.77%) patients. Skin-related infections were observed in 37 (24.83%) patients, primarily associated with intravenous drug use. Oral thrush was present in 11 (7.38%) patients. Other infections included urinary tract infections in 5 (3.35%) patients and various less common OIs. Conclusion: The study revealed that OIs remain a significant health challenge for HIV-positive individuals, with a notable prevalence of respiratory and skin infections. Early and sustained ART, along with preventive healthcare measures, are crucial in managing and reducing OIs.

Spectrum of Opportunistic Infections in People Living with HIV: A Tertiary Care Center Experience from North India

: Patients with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) are proneto opportunistic infections (OIs) given their immunosuppressed state. OIs continue to cause morbidity and mortality in HIV/AIDS patients even after highly-active antiretroviral therapy (HAART); hence, attainment of the goals on health care programs,particularly in resource-poor countries, is hard to achieve. The prevalence of specific OIs varies in different countries and evenin different areas within the same country. Little information is available about the prevalence of OI in HIV patients fromdeveloping countries, especially India. Early diagnosis and prompt treatment contribute to increased life expectancy amonginfected patients delaying progression to AIDS. Hence, the present study was carried out to elucidate current frequencies andspectrum of OIs in HIV seropositive adult patients in Haryana and to evaluate the associated risk factors for OIs. Materialsand methods: This was a cross-sectional study carried out at the Dept. of General Medicine in a tertiary care hospital in NorthIndia. Basic demographic details, anthropometric measurements, symptoms of HIV/OI, clinical examination, biochemicalinvestigations and treatment details were recorded. Patients aged 18 to 70 years and HIV seropositive subjects were includedin the study. Results: The study found that about 53.21% of HIV/AIDS patients on ART had one or more OIs. Tuberculosis(TB) was the predominant OI identified, with a prevalence of 25.71%. Candidiasis and herpes zoster were the second and thethird most prevalent OIs at 13.8% (101/731) and 7.25% (53/731), respectively. Age (43.4 ± 10.7 years), low income, illiteracy,low socioeconomic status, initial 4 months since initiation of ART, CD4 count <200/mm3, body mass index of <18.5 kg/m², poorART adherence, hemoglobin, albumin were strongly associated with OIs. Conclusion: The present study shows that TB is thecommonest OI in adults and the overall population of people living with HIV (PLHIV) in Haryana and proves that OIs acrossdifferent patient groups vary significantly. Various factors like adherence to HAART, socioeconomic and education status ofpatients can influence the occurrence and outcome of these deadly infections.

Risk Factors Associated with Opportunistic Infections among People Living with HIV/AIDS and Receiving an Antiretroviral Therapy in Gabon, Central Africa.

The Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) is still one of the main causes of death in sub-Saharan Africa. Antiretroviral therapies (ARTs) have significantly improved the health conditions of people living with HIV/AIDS (PLWHA). Consequently, a significant drop in morbidity and mortality, along with a reduced incidence of opportunistic infections (OIs), has been observed. However, certain atypical and biological profiles emerge in ART patients post-examination. The objective of this study was to identify the risk factors that contributed to the onset of OIs in HIV patients undergoing ART in Gabon. Epidemiological and biological data were obtained from medical records (2017 to 2019) found at the outpatient treatment centre (CTA) of Franceville in Gabon. Samples for blood count, CD4, and viral load analysis at CIRMF were collected from PLWHA suffering from other pathogen-induced conditions. A survey was carried out and data were analysed using Rstudio 4.0.2 and Excel 2007 software. Biological and socio-demographic characteristics were examined concerning OIs through both a univariate analysis via Fisher's exact tests or chi2 (χ2), and a multivariate analysis via logistic regression. Out of the 300 participants initially selected, 223 were included in the study, including 154 (69.05%) women and 69 (30.95%) men. The mean age was 40 (38.6; 41.85), with individuals ranging from 2 to 77 years old. The study cohort was classified into five age groups (2 to 12, 20 to 29, 30 to 39, 40 to 49, and 50 to 77 years old), among which the groups aged 30 to 39 and 40 to 49 emerged as the largest, comprising 68 (30.5%) and 75 (33.6%) participants, respectively. It was noted that 57.9% of PLWHA had developed OIs and three subgroups were distinguished, with parasitic, viral, and bacterial infections present in 18%, 39.7%, and 55.4% of cases, respectively. There was a correlation between being male and having a low CD4 T-cell count and the onset of OIs. The study revealed a high overall prevalence of OIs, and extending the study to other regions of Gabon would yield a better understanding of the risk factors associated with the onset of these infections.

Modern aspects of central nervous system damage in patients with HIV infection (literature review)

The literature review highlights modern ideas about the pathogenesis, pathomorphology, and clinical manifestations of central nervous system damage in patients with HIV infection, and also touches on the problems of diagnosis and treatment of these opportunistic infections. Particular attention should be paid to patients with severe immunodeficiency (CD4+T-lymphocyte count < 200 cl/ml) due to the high risk of secondary diseases of the central nervous system. Along with the etiological verification of opportunistic diseases of the central nervous system, magnetic resonance imaging of the brain is important at the initial stage of diagnosis, with the help of which it is possible to identify changes in the brain substance characteristic of certain pathogens. In addition to the basic etiotropic therapy of opportunistic infections in HIV patients, effective antiretroviral therapy and its index of penetration into the central nervous system play a crucial role.

Metagenomic Next-Generation Sequencing for the Diagnosis of Suspected Opportunistic Infections in People Living with HIV.

ObjectiveThe diagnosis of suspected opportunistic infections in HIV patients is challenging due to the wide range of potential causes. This study used mNGS to analyse specimens of suspected opportunistic infections in HIV patients from a single centre to explore this method’s applicability as a diagnostic tool compared to that of CMTs.MethodsWe retrospectively investigated 46 suspected opportunistic infections in people living with HIV(PLWH) Hospitalized at Hangzhou Xixi hospital from January 2020 to August 2021. In total, we collected 49 samples (3 patients provided 2 samples) and sent them out for mNGS.ResultsmNGS had a better detection rate for fungi and nontuberculous mycobacteria than that of CMTs. Specifically, the diagnostic detection rate of fungi (11 vs 19, P<0.05) and nontuberculous mycobacteria (1 vs 6, p<0.05) was significantly higher; there was no difference in detection rate for other pathogens (bacteria, Mycobacterium tuberculosis, or viruses). The sensitivity of mNGS was 90.91%, 50%, 0%, 100%, and 100% for detecting fungi, bacteria, Mycobacterium tuberculosis, nontuberculous mycobacteria, and viruses, respectively; the corresponding specificities were 74.29%, 97.73%, 86.36%, 86.67%, and 91.11%.ConclusionmNGS technology provides an alternative and promising method of identifying suspected opportunistic infections in PLWH. Thus, the best diagnosis strategy may be using a combination of mNGS and CMTs.

Cryptosporidium species in HIV patients in Alexandria, Egypt: distribution and associated clinical findings.

Cryptosporidium sp. cause opportunistic infections in HIV patients. Molecular differentiation provides a better understanding of the epidemiology and clinical variations of cryptosporidiosis. The present work studied the species of Cryptosporidium in HIV patients and their associated demographic and clinical features. The study included 100 adult HIV patients receiving antiretroviral therapy in Egypt. Cryptosporidium infection was diagnosed by modified Ziehl- Neelsen (MZN) stain and PCR amplification of COWP gene. The infecting species were molecularly identified by restriction fragment length polymorphism (RFLP) and DNA sequencing. Data were analyzed using Kappa ( K) agreement, Mann-Whitney U, odds ratio and the 95% confidence interval, Chi-squared and Monte Carlo significance (MCp) tests. The statistical significance was judged at the 5% level. A total of 16 Cryptosporidium positive cases were detected (16%), with good agreement between PCR and MZN ( K = 0.763). Among 11 PCR positive samples, RFLP identified C. hominis in five samples, C. parvum in three samples, C. meleagridis in two samples, and mixed C. hominis and C. meleagridis in one sample. Eight samples were successfully sequenced and the results confirmed the RFLP classification. C. hominis was found mainly in urban residents while C. parvum and C. meleagridis were significantly associated with rural areas (MC p =0.01). Diarrhoea and nausea/vomiting were recorded only in the presence of C. hominis infection while abdominal pain was the main symptom in C. parvum and C. meleagridis infections. Drinking water sources, contact with animals, and CD4+ count were not related to infection with a particular species. In conclusion, infection with Cryptosporidium sp. is common and frequently symptomatic in HIV patients in Egypt. The predominant species, C. hominis, C. parvum, and C. meleagridis show a distinct distribution in urban and rural residents.

Immunological factors, but not clinical features, predict visceral leishmaniasis relapse in patients co-infected with HIV

SummaryVisceral leishmaniasis (VL) has emerged as a clinically important opportunistic infection in HIV patients, as VL/HIV co-infected patients suffer from frequent VL relapse. Here, we follow cohorts of VL patients with or without HIV in Ethiopia. By the end of the study, 78.1% of VL/HIV—but none of the VL patients—experience VL relapse. Despite a clinically defined cure, VL/HIV patients maintain higher parasite loads, lower BMI, hepatosplenomegaly, and pancytopenia. We identify three immunological markers associated with VL relapse in VL/HIV patients: (1) failure to restore antigen-specific production of IFN-γ, (2) persistently lower CD4+ T cell counts, and (3) higher expression of PD1 on CD4+ and CD8+ T cells. We show that these three markers, which can be measured in primary hospital settings in Ethiopia, combine well in predicting VL relapse. The use of our prediction model has the potential to improve disease management and patient care.

Intestinal Parasitosis and its Association with CD4+ T Cell Count and Viral Load among People Living with HIV in Parasite Endemic Settings of Northwest Ethiopia.

PurposeTo study intestinal parasitosis and its association with viral load and CD4+ T cell count in HIV-infected individuals at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.MethodsA cross-sectional study was conducted from March to June 2019. Three hundred and sixteen study participants were selected using systematic random sampling technique. Sociodemographic and clinical data were collected using structured questionnaire. Stool samples were collected and examined using direct saline, formol ether concentration technique and modified acid fast staining. CD4+ T cell counts and viral load were determined by fluorescence-activated cell sorting (BD FACS) and COBAS Ampliprep/COBAS TaqMan HI2CAP assay, respectively. Data were entered into Epi Data 3.1 and transferred to SPSS version 20 software for analysis. Bivariable and multivariable analyses were performed using a binary logistic regression model. P values of less than 0.05 were considered statistically significant.ResultsThe overall prevalence of intestinal parasitosis was 24.7% (78/316). The most commonly detected parasite was Cryptosporidium species with 5.4% (17/316), followed by Ascaris lumbricoides with 5.1% (16/316). There was a significant association with low CD4+ T cell count (AOR: 3.207; 95% CI: 1.237, 8.317), high viral load (AOR: 2.933; 95% CI: 1.326, 6.489), individuals aged 31–40 years (AOR: 0.305; 95% CI: 0.124, 0.751) and individuals aged 41–50 years (AOR: 0.261; 95% CI: 0.101, 0.671).ConclusionIn this study, prevalence of intestinal parasitic infections was high and was associated with low CD4+ T cell count and high viral load. Therefore, screening of HIV patients, especially those with low CD4+ T-cell count and high viral load, particularly for opportunistic intestinal parasitic infections would be of utmost importance in the efforts to prevent and control opportunistic infections in HIV patients.

MICROBIAL PATTERNS OF HOSPITALIZED HIV POSITIVE PATIENTS ADMITTED IN DR. SOETOMO GENERAL HOSPITAL, SURABAYA INDONESIA

Background: HIV patients with a weak immune system are very vulnerable to opportunistic infections, can trigger systemic endothelial activation and end up as a condition of sepsis. In Indonesia currently, there is no bacterial epidemiological mapping of the etiology of opportunistic infections in HIV patients. Purpose: To determine the pattern of bacteria that cause opportunistic infections and their antibiotic sensitivity in HIV patients. Method: Prospective observational study design. Data were obtained from medical records of hospitalized patients at RSUD Dr. Soetomo Surabaya from August 2019 - February 2020. Result: Out of 64 patients, 83 specimens were found with the most types of gram-negative bacteria 44.6%, while gram-positive bacteria were 15.7% and a mix of 2.4% and 37.3% negative culture. The highest prevalence of gram-negative bacteria was Klebsiella pneumoniae (35.15), followed by Escherichia coli (10.8%), Pseudomonas aeruginosa (8.1%), and Acinetobacter baumanii (8.1%). The highest prevalence of gram-positive bacteria was Streptococcus mitis / oralis (30.7%), followed by Staphylococcus aureus (23.1%) and Staphylococcus epidermidis (15.4%). Among gram-negative bacteria antibiotic, Cefoperazone-sulbactam showed the greatest sensitivity, following by Amikacin, Gentamycin and Piperacillin-tazobactam; while among gram-positive bacteria are Chloramphenicol, Linezolid, and Vancomycin. Almost all isolates showed resistance to Ampicillin. Conclusion: Bacteria pattern that caused opportunistic infection in RSUD Dr. Soetomo is K. pneumonia as most common gram-negative bacteria followed by E. coli, P. aeruginosa and A. baumanii; while the most gram-positive bacteria found are S. mitis/oralis and S. aureus. Among antibiotic used, Ampicillin showed the lowest sensitivity to almost all bacteria isolates.

Virologic and immunologic status of children with HIV-TB co-infections

Background Studies about virologic and immunologic status of HIV children are lacking. Tuberculosis (TB) is the most common opportunistic infection in HIV patients and co-infection is associated with much worse prognosis.&#x0D; Objective To describe the virologic and immunologic status of patients with HIV and TB co-infection, before and after HIV and TB treatment.&#x0D; Methods A prospective study was conducted in HIV co-infected with TB patients in an Indonesian tertiary hospital between November 2016—December 2018. Viral load and CD4 levels were performed at diagnosis and after 6 months of HIV and TB treatment.&#x0D; Results Of 44 children hospitalized due to HIV, 15 newly diagnosed HIV cases had TB co-infection. Thirteen were included as subjects. Most patients (10/13) were under 5 years of age, with similar female and male proportions (7/13 vs. 6/13, respectively). All were diagnosed with stage 4 HIV. Six patients had respiratory problems at admission. First examinations revealed severe immunodeficiency (CD4+ &lt;20%) in all patients, and high viral loads (&gt;105 copies/mL) in most (9/13) patients. Despite good compliance to medications, 8/13 patients died before the sixth month follow-up. Deterioration of virologic and immunologic status was seen in 3/4 of the followed-up patients.&#x0D; Conclusion Children with HIV-TB coinfections have severe immunodeficiency and high viral loads. Most such patients die before 6 months, while survivors experience virologic and immunologic status deterioration. Future study must take into account for HIV drug resistance investigation.

HIV-Associated Disseminated Histoplasmosis and Rare Adrenal Involvement: Evidence of Absence or Absence of Evidence.

Adrenal histoplasmosis and primary adrenal insufficiency are mostly described in immunocompetent patients. This particular tropism is attributed to the presence of cortisol within the adrenal gland, a privileged niche for Histoplasma growth. In French Guiana, disseminated histoplasmosis is the main opportunistic infection in HIV patients. Our objective was to search in our HIV-histoplasmosis cohorts to determine how frequent adrenal insufficiency was among these patients. Between January 1, 1981 and October 1, 2014, a multicentric retrospective, observational study of histoplasmosis was conducted. Patients co-infected by HIV and histoplasmosis were enrolled in French Guiana’s histoplasmosis and HIV database. Among 349 cases of disseminated histoplasmosis between 1981 and 2014, only 3 had adrenal insufficiency (0.85%). Their respective CD4 counts were 10, 14 and 43 per mm3. All patients had regular electrolyte measurements and 234/349 (67%) had abdominal ultrasonography and 98/349 (28%) had abdominopelvic CT scans. None of these explorations reported adrenal enlargement. Overall, these numbers are far from the 10% reports among living patients and 80-90% among histoplasmosis autopsy series. This suggests 2 conflicting hypotheses: First, apart from acute adrenal failure with high potassium and low sodium, less advanced functional deficiencies, which require specific explorations, may have remained undiagnosed. The second hypothesis is that immunosuppression leads to different tissular responses that are less likely to incapacitate the adrenal function. Furthermore, given the general immunosuppression, the adrenal glands no longer represent a particular niche for Histoplasma proliferation.

Profile of fungal opportunistic infection in HIV/ AIDS patients: An appraisal at Indian tertiary care

AIDS is characterized by a number of opportunistic infections which are responsible for high morbidity and mortality. The spectrum and distribution of opportunistic infection (OIs) in AIDS patients is due to viral, Bacterial, Fungal cytopathology and are secondary to the failure of both cellular and humeral response with CD4 count of &amp;#60;200 mm leads to morbidity and mortality. To document the spectrum of Fungal opportunistic infections in various age groups of HIV/AIDS patients and to note the CD4 counts among the group This is a descriptive study. Clinically and laboratory confirmed fungal cases of opportunistic infections in HIV patients are recorded, during the one year period from June 2017 - May 2018. Blood of these patients processed for CD4 counts, by Partec flow cytometery to assess the immune status among them. Out of 500 HIV seropositive cases, we found 65 of fungal opportunistic infections accounting for 13% of the cases. Majority of opportunistic infections, were in the age group of 31-40 years (37.8%) with predominance of male accounting for 55.2% of the cases. Out of 65 cases, 9.2% had oral candidiasis followed by 1% of vaginal candidaisis with CD4 count &amp;#60;100 mm. In our study, predominant lesion observed was oral candidiasis among all the fungal opportunistic infections. Our study will help in programme management and to plan appropriate strategies for the investigation and treatment of common OIs as a part of management programme for HIV infected populations.

Modulation of host immune status by cryptococcus co-infection during HIV-1 pathogenesis and its impact on CD+4 cell and cytokines environment

BackgroundCryptococcus infection is the second most common opportunistic infection in HIV patients with an increased rate of morbidity and mortality. Altered immune system during HIV- Cryptococcus co-infection is yet to be explored by laboratory. This study evaluates pro- and the anti-inflammatory cytokines in HIV patients with Cryptococcus co-infection and correlate them with CD4+T cell counts as well as viral loads before the initiation of drug therapy. This information would enable to understand host immune modulation and cellular environment during co-infection and understand its impact on HIV pathogenesis. MethodologyThe study comprised four categories of patients with cryptococcosis, HIV, HIV-cryptococcosis co-infected and asymptomatic Healthy volunteers. All the patients and healthy individuals were subjected to CD4+T cells count by FACS using monoclonal antibody cocktail CD4+T cell count (counts per mm3) which was counted using multiSET software on FACS caliber. The viral loads were counted in terms of viral RNA copy numbers which was estimated by real-time PCR using by Artus HIV-1 RG. The sensitivity of kit was >70 IU/ml. ELISA was performed for IL-12 p70, IL-12, IL-4, IL-10, IL-6, TNF-α and IFN-Y using commercially kits (BD Biosciences, USA). Significant variations were assayed by Student's t-test and P values ≤ 0.05 were considered statistically significant. ResultsReduction in CD+4 cell counts was highly significant in HIV patients with or without cryptococcosis. CD4+T cell counts were inversely proportional to viral load. TNF-α levels were raised in cryptococcosis patients significantly higher than healthy individuals. TNF-α was more or less not dependent on viral load but it was more related to the cryptococcosis IL-12 levels were increased in patients with infection and was highest in the HIV infected group. Level of IL-4 was similar in healthy and patients with cryptococcosis but it was elevated in HIV-Crypto co-infected patients. HIV infected patients showed a significant increase in IL-4 level and it was elevated higher in co-infected patients. IL-10 and IL-6 were significantly higher in HIV patients. The fungal infection did not influence the levels of IL-10 in HIV group but IL-6 was low in fungal infected patients. ConclusionThere are very limited studies related to the immune modulation status of HIV co-infected with Cryptococcus before the initiation of any drug therapy. Such information might through in-depth light to understand the initial state of the immune environment which certainly would play a pivotal role in the outcome of the immune modulation.

Multiplex Real-time PCR Detection of Intestinal Protozoa in HIV-infected Children in Malawi: Enterocytozoon Bieneusi Is Common and Associated With Gastrointestinal Complaints and May Delay BMI (Nutritional Status) Recovery.

Intestinal protozoa are common opportunistic infections in HIV patients. Longitudinal studies on either the clinical relevance or the effect of immune reconstitution by antiretroviral therapy on intestinal protozoan infections in children are lacking however. This study investigates prevalence and clinical relevance of intestinal protozoa in HIV-infected Malawian children before and during their first year of antiretroviral treatment (ART). Stool samples collected at enrolment and during follow-up were tested for nonopportunistic (Giardia lamblia, Dientamoeba fragilis, Entamoeba histolytica) and opportunistic protozoa (Enterocytozoon bieneusi, Encephalitozoon spp., Cryptosporidium spp. and Cystoisospora belli) using multiplex real-time polymerase chain reaction. Associations between infections and clinical symptoms were evaluated using univariate methods. Nonopportunistic and opportunistic protozoa were detected in 40% (14/35) and 46% (16/35) of children at baseline, respectively. E. bieneusi was the most prevalent protozoa (37%, 13/35) and associated with gastrointestinal complaints (43% in positive (10/13) versus 18% (4/22) in E. bieneusi-negative children, P = 0.001. Body mass index recovery during 12 months of ART was more commonly delayed in E. bieneusi-positive children (+0.29 +standard deviation 0.83) than E. bieneusi-negative children (+1.03 +standard deviation 1.25; P = 0.05). E. bieneusi was not detected after 12 months of ART. E. bieneusi was the most prevalent opportunistic intestinal protozoa, present in over a third of study participants before initiation of ART. Although all children cleared E. bieneusi after 12 months of ART, E. bieneusi was associated with gastrointestinal complaints and may delay body mass index recovery. Trials to assess effect of treatment of E. bieneusi on nutritional status should be considered in HIV-infected African children.

Isolation and evaluation of Candida species and their association with CD4+ T cells counts in HIV patients with diarrhoea.

Gastrointestinal infection is one of the most common infections among HIV patients. Candida spp have been implicated in the aetiology of chronic diarrhoea in HIV patients, but little is known about this in Nigeria. We determined the prevalence of faecal candidiasis in HIV patients in relation to diarrhoea, CD4 counts, and other socio-demographic factors and the spectrum of Candida isolates involved. One hundred and fifty four HIV patients were investigated. Candida species were identified by standard techniques. Socio-demographic and clinical information was obtained from the patients using a structured questionnaire. The CD4 count was estimated using a single platform flow cytometer. Candida overgrowth was detected in 61 (39.5%) HIV patients, and diarrhoea was associated with candidiasis in the subjects (P=0.001). Candidiasis was commonly detected among subjects in the 29-39 years' age group. A CD4 count below 200 cells/mm2 (62.3%) was a risk factor for acquiring candidiasis among HIV patients (P=0.001). Candida albicans (65.6%) was the most frequently recovered species followed by Candida krusei (16.4%) and Candida tropicalis (14.8%). Candidiasis is an important opportunistic infection in HIV-patients in Ile-Ife. There is need for regular checks for opportunistic infections, including candidiasis in HIV patients to monitor disease progression and prevent subsequent complications.

High levels of plasma interferon gamma and +874T/A gene polymorphism is associated with HIV-TB co-infection

ObjectiveTuberculosis (TB) is one of the most frequent opportunistic infections in HIV patients leading to increased morbidity and death rate. This study was carried out to investigate the role of the cytokines IFN-γ and TNF-α level and their single nucleotide polymorphisms (SNPs) in HIV-TB co-infection. Methods247 HIV-TB (124 HIV-pulmonary TB, 123 HIV-extra pulmonary TB), 126 HIV positive individuals without tuberculosis and 129 healthy subjects (HS) were included to measure plasma levels of IFN-γ and TNF-α by sandwich ELISA and One way ANOVA statistical analysis was carried out among the groups. The SNPs of TNF-α-308 G/A, -238 G/A and IFN-γ+874 T/A were also investigated using amplification refractory mutation system polymerase chain reaction (ARMS-PCR). The frequencies between the groups were compared by Pearson’s chi square statistical analysis. ResultsPlasma IFN-γ and TNF-α were significantly elevated in HIV-TB and TB (p<0.05) as compared to those in HS group. There was significant association between IFN-γ+874 ‘A’ allele and AA genotype in HIV-TB groups compared to HS and HIV (p<0.05) and no such association was found for TNF-α-308 and -238. The plasma cytokine levels of TNF-α and IFN-γ reveals no significant association with levels of IFN-γ+874 T/A, TNF-α -308 G/Aand-238 G/A genotypes in any of the study groups. ConclusionIn conclusion, the present study revealed elevated plasma IFN-γ and its +874 ‘A’ allele are associated with HIV-TB co-infection indicating 1.6 times increased risk for TB susceptibility. Elevated TNF-α levels in TB and HIV-TB suggest its involvement in TB pathogenesis.

Étude rétrospective de la cryptococcose neuroméningée chez les patients infectés par le VIH dans le service des maladies infectieuses du CHU de Casablanca, Maroc

To report the cases of neuromeningeal cryptococcosis and to describe the clinical, paraclinical, therapeutic and outcomes of patients. Retrospective study of 43 patients infected with HIV admitted from January first 2010 to June 30th 2015 in the infectious disease unit of UHC Ibn Rochd, for neuromeningeal cryptococcus. The mean frequency of neuromeningeal cryptococcosis in patients infected with HIV was 1.4%. The mean age was 39 years and a sex ratio of 1.38. The mean CD4 count was 70 cells/mm3. The diagnosis of HIV was revealed by neuromeningeal cryptococcus in 77% of cases. Fifteen days interval was reported between the first symptom and hospital admission. Headache (77%) was the most represented clinical sign. The cerebrospinal fluid analysis showed hypoglycorachy (67%), hyperproteinorachy (65%) and lymphocytosis (63%). Chinese ink direct examination for Cryptococcus neoformans in CSF was positive in 86% of cases and all cases were positive after culture on Sabouraud's medium. Patients were treated with monotherapy amphotericin B (42%) or fluconazole (28%) and bitherapy amphotéricine B/fluconazole (28%). Fatal evolution was observed in 60% of cases. Neuromeningeal cryptococcosis remains a severe opportunistic infection in HIV patients with a heavy mortality rate.

Afectación hepática en enfermedades infecciosas. Hepatopatías en pacientes inmunodeficientes

IntroductionIt is frequent to observe an abnormal liver function test or liver related symptoms in the course of systemic infections. Nevertheless, these conditions do not always mirror a direct liver colonization and can be due to indirect liver damage mediated by endotoxemia and bacteriemia as well as an ischemic injury in the context of severe sepsis. EtiopathogenesisThe etiology of liver disease due to infections includes bacteria, virus, yeast and parasites. EpidemilogyThe frequency of the different mentioned pathogens is related to both the geographic location and the immunologic condition of the host. ObjectiveThis review is focused on liver manifestations during different systemic infections as well as the liver involvement in the most common opportunistic infections in HIV patients.

Prevalence and risk factors for opportunistic infections in HIV patients who developed adverse drug reactions (ADRs) to antiretroviral therapy (ART) in a tertiary-care teaching hospital

Background: The introduction of highly active antiretroviral therapy (HAART) has led to decline in HIV-related opportunistic infections (OIs). Knowledge of the most common OI of that geographical area will help in implementing the preventive measures against that pathogen. We determined the prevalence and risk factors for OIs among patients who developed adverse drug reaction (ADR) to antiretroviral therapy (ART) in a tertiary-care teaching hospital. Aims and Objective: To collect demographic details of HIV-positive patients who were on ART and developed ADR to ART with OI and without OI; to determine the prevalence of OIs in HIV-positive patients who developed ADR to ART; and to investigate the sociodemographic and clinical risk factors associated with their occurrence. Materials and Methods: A cross-sectional study carried out between January and June 2012. The study population comprised HIV-infected patients, who were receiving ART at ART Center, KR Hospital of Mysore Medical College and Research Institute, Mysore, Karnataka, India, who developed ADRs to ART with or without OI. Results: The prevalence of OI was 50.63%. The sociodemographic variables that had significant positive association with the presence of OIs on univariate analysis includes employment [odds ratio (OR) = 4.96, 95% confidence interval (CI) = 2.52–9.75; p = 0.00). The risk of OIs did not significantly differ according to gender (OR = 0.77, 95% CI = 0.41–1.45; p = 0.21), age (OR = 1.658, 95% CI = 0.82–3.32; p = 0.079), residence (OR = 0.812, 95% CI = 0.43–1.52; p = 0.26), literacy (OR = 0.90, 95% CI = 0.48–1.70; p = 0.38), marital status (OR = 1.8, 95% CI = 0.70–4.61; p = 0.11), or weight (OR = 1.69, 95% CI = 0.84–3.42; p = 0.07). The univariate analysis of clinical risk factors for OIs had a significant positive association with WHO staging (OR = 24.04, 95% CI = 5.5–105.01; p = 0.00) and CD4 count (OR = 2.61, 95% CI = 1.32–5.16; p = 0.00). The risk of OIs did not significantly differ with adherence (OR = 0.37, 95% CI = 0.07–1.99; p = 0.13). Conclusion: OIs remain a challenge in patients receiving ART in resource-limited settings. There is a need to intensify the management of OIs despite ART use.