Pattern Of Opportunistic Infections Research Articles

A pattern of Opportunistic Infections among HIV In patients on Antiretroviral Therapy in a Tertiary Care Hospital in Coastal Karnataka: A Retrospective Evaluation

Though the incidence of opportunistic infection (OI) is reducing with combination antiretroviral therapy. In this study we aimed to identify the pattern of the occurrence of opportunistic infections in HIV (Human Immunodeficiency Virus) patients. This was a retrospective, case-record based, time-bound study over a four year period (2013-2016) which included HIV positive in-patients aged >18 years of age, of either gender on Antiretroviral Therapy (ART). Demographic details, details of HIV infection including baseline and all available CD4 counts, details of the medications were recorded. Adverse drug reactions (ADR) were recorded by reviewing patient records. Among the files checked, 298 inpatients were on ART regimens recommended by the National AIDS Control Organization (NACO), and were included in the study. Among them, 70.8% of patients developed atleast one OI, 29.8% developed two OIs, and 6.71% developed three OIs. The most common OI was pulmonary tuberculosis (48.3%). The most common ART regimen was a combination of Zidovudine + Lamivudine + Nevirapine. In our study, 70.8% of patients developed at least one OI, which suggests that despite availability of combination ART, OIs continue being a significant issue in patients with HIV in resource-limited settings.

Frequency and distribution patterns of opportunistic infections associated with HIV/AIDS in Uganda.

BackgroundWe conducted a study to assess the frequency and distribution patterns of selected opportunistic infections (OIs) and opportunistic cancers (OCs) in different geographical areas before and after HAART in Uganda.MethodsThis was a cross-sectional serial review of observation data for adult HIV positive patients (≥15 years) enrolled with the AIDS support organization (TASO) in Uganda covering the period from January 2001 to December 2013. Both AIDS defining OIs/OCs and non-AIDS defining OIs were analyzed. The study period was structured into three time periods: “pre- HAART” (2001–2003), “early-HAART” (2004–2008) and “late-HAART” (2009–2013). Descriptive statistics were used to summarize the data by time period, age, gender and geographical location. Chi squared test used to test the significance of the differences in proportions.ResultsA total of 108,619 HIV positive patients were included in the analysis. 64% (64,240) were female with median age of 33 years (IQR 27–40). The most frequent OIs before HAART were oral candida (34.6%) diarrhoeal infection (<1 month) (30.6%), geohelminths (26.5%), Mycobacterium tuberculosis (TB) (17.7%), malaria (15.1%) and bacterial pneumonia (11.2%). In early HAART (2004–2008), the most frequent OIs were geohelminths (32.4%), diarrhoeal infection (25.6%), TB (18.2%) and oral candida (18.1%). In late HAART (2009–2013), the most frequent OIs were geohelminths (23.5%) and diarrhoeal infection (14.3%). By gender, prevalence was consistently higher in women (p < 0.05) before and after HAART for geohelminths, candidiasis, diarrhoeal infection, bacterial pneumonia and genital ulcer disease but consistently higher in men for TB and Kaposi’s sarcoma (p < 0.05). By age, prevalence was consistently higher in older age groups (>30 years) before and after HAART for oral candida and TB (p < 0.05) and higher in young age groups (<30 years) for malaria and genital ulcers (p < 0.05). By geographical location, prevalence was consistently higher in Eastern and Northern Uganda before and after HAART for diarrheal infection and geohelminths (p < 0.0001).ConclusionsThe frequency and pattern of OIs before and after HAART differs by gender, age and geographical location. Prevalence of geohelminths and diarrhea infection(<1 month) remains high especially in Northern and Eastern Uganda even after HAART and should therefore be given special attention in HIV/AIDS care programmes in these settings.

Socio-Clinical Profile Of HIV Patients Visiting To An Art Centre

Introduction: Scenario of the AIDS epidemic, clinical course and pattern of opportunistic infections in HIV patients is changing world-wide. The study aims to fulfill the paucity of socio-clinical profi le among the patient of HIV with geographical population of this region. Methodology: This is a hospital based cross sectional clinical study with a sample size of 110 respondents presenting to ART center at Jayarogya Hospital (JAH) Gwalior from May 2010 to Oct 2011. Results: Mean age of study population was 35.44±9. High Frequency of weight loss &gt; 10% (P&lt;0.001), fever (P=0.0027), breathlessness (P=0.03), itching (P&lt;0.001), lymphadenopathy (P&lt;0.001), oral thrush (P=0.006), extra pulmonary tuberculosis (P=0.04), candidiasis (P=0.006) at low CD4 count (&lt;200) and difference in mean CD4 count (P=0.0039) among male (202.21) and female (291.41) was found to be statistically signifi cant. CD4 counts of the patients were signifi cantly inversely correlated with the number of opportunistic infections and the number of symptoms (R=-0.369; P&lt;0.001, R=-0.223; P=0.019 respectively). Conclusion: The study depicts male predominance, young sexually active group vulnerability, with a quite difference in clinical presentation and occurrence of opportunistic infections from other part of the world necessitating formulation of different set of guidelines for subjects of Indian subcontinent to improve life-span of such patients. SAARC Journal of Tuberculosis, Lung Diseases &amp; HIV/AIDS; 2013; X(2); 7-14 DOI: http://dx.doi.org/10.3126/saarctb.v10i2.9707

Pattern of opportunistic infections and cytological changes in sputum specimen from HIV infected patients at Mbagathi District Hospital, Nairobi, Kenya

<h3>Background</h3> Opportunistic infections are a major cause of death amongst HIV infected patients. Sputum is one of the specimens that have the potential for utilization in making a diagnosis of these opportunistic infections. <h3>Aim</h3> To describe the types of opportunistic infections and cyto-logical changes in sputum specimens in HIV infected patients attending Mbagathi District Hospital Nairobi Kenya. <h3>Material</h3> Total of 100 HIV infected patients attending Mbagathi District Hospital from February to June 2013 were included in this study. Two sputum samples per patient were obtained from the 100 HIV infected patients, concentrated using bleach method and centrifuged and then stained with ZN and H&E stains. <h3>Results</h3> HIV infected patients were mostly 31–40 years with 53% having a CD4+ count below 200 cells/mm³. The most common opportunistic pathogen was Mycobacterium species (30%) and Candida species (14%). No association was found between opportunistic pathogens and CD4+ count. Inflammatory changes were seen in 57% of patients, atypical squamous cells of undetermined significance (ASCUS) in 4%, and negative findings in 34%. <h3>Discussion</h3> Sputum cytology can be used for preliminary diagnoses of opportunistic pathogens before confirmatory test.

Prevalence of HIV-TB co-infection, clinical profile and CD4 count of HIV patients attending ART centre of Ahmednagar, Maharashtra

Background: HIV-TB co-infection has become a major public health problem worldwide. TB has become the major cause of death in HIV positive patients. Clinical course and pattern of opportunistic infections in HIV patients is changing world-wide. Aims & Objective: To study prevalence of HIV-TB co-infection and socio-demographic & clinical profile of HIV-AIDS patients attending anti-retroviral therapy (ART) centre in a rural area, Ahmednagar district of Maharashtra. Materials and Methods: A cross-sectional study was conducted from November 2013 to April 2014 at an antiretroviral therapy centre of a rural tertiary care hospital, situated in Maharashtra state of India. Interview of 385 HIV positive individuals was taken by using pre-designed questionnaire which included socio-demographic and clinical profile, opportunistic infections and CD4 counts of the patients. Results: More than two third (71.43%) of the study population were in sexually active age group i.e. 30-45 years. Females were 46.8% and males were 53.2%. Most of them were from upper lower socioeconomic (46.23%) and lower (secondary level) educational status. Fatigue, weight loss, fever, cough, diarrhoea were common clinical features. Most common opportunistic infection was herpes zoster (47.27%). Heterosexual route was main route of transmission. Most of the female respondents were widows (66.67%) and 48.29% were discordant couple. 46.75% patients were in the third stage of disease. Mean CD4 count at the start of treatment was 152.9 ± 92.45. Prevalence of HIV-TB co-infection was 21.56%. Conclusion: Opportunistic infections were associated with CD4 count and CD4 count was associated with A.R.T. therapy. Primary as well as secondary preventive measures could be implemented effectively.

P.022 Human cytomegalovirus (HCMV) UL40 variability in renal transplant recipients

Bronchoalveolar lavage (BAL) is a useful tool in the diagnosis of pulmonary infections in immunocompromised patients. We aimed to compare the spectrum of infectious pulmonary complications diagnosed using BAL in a large consecutive cohort of immunocompromised patients.The diagnostic yield of 1066 BAL specimens was analyzed in 4 different groups of immunocompromised patients (HIV; solid organ transplants; high-dose chemotherapy and/or stem cell transplants; other immunosuppressive therapy) suffering from fever, respiratory symptoms and/or infiltrates on chest X-ray. Specimens were analyzed for bacteria, mycobacteria, fungi, Pneumocystis jiroveci, cytomegalovirus (CMV) and other viruses. Two time periods were compared (1992–1996; 1997–2003).The overall diagnostic yield of BAL was 34% for bacteria, 22% for CMV, 15% for P. jiroveci, 6% for other viruses, 6% for mycobacteria and 2% for aspergillus. There were significant changes in the pattern of opportunistic infections between the 2 time periods. Mycobacterial infections decreased considerably in the HIV group (17.9 vs. 8.5%, P=0.02), while the incidence of P. jiroveci decreased mainly in the transplant group (32.6 vs. 7.9%, P<0.00001).This study demonstrates a changed pattern of pulmonary infections in immunocompromised patients diagnosed by BAL. The overall diagnostic yield of BAL remains high in immunocompromised patients with respiratory symptoms.

Pulmonary infections diagnosed by BAL: A 12-year experience in 1066 immunocompromised patients

Bronchoalveolar lavage (BAL) is a useful tool in the diagnosis of pulmonary infections in immunocompromised patients. We aimed to compare the spectrum of infectious pulmonary complications diagnosed using BAL in a large consecutive cohort of immunocompromised patients. The diagnostic yield of 1066 BAL specimens was analyzed in 4 different groups of immunocompromised patients (HIV; solid organ transplants; high-dose chemotherapy and/or stem cell transplants; other immunosuppressive therapy) suffering from fever, respiratory symptoms and/or infiltrates on chest X-ray. Specimens were analyzed for bacteria, mycobacteria, fungi, Pneumocystis jiroveci, cytomegalovirus (CMV) and other viruses. Two time periods were compared (1992-1996; 1997-2003). The overall diagnostic yield of BAL was 34% for bacteria, 22% for CMV, 15% for P. jiroveci, 6% for other viruses, 6% for mycobacteria and 2% for aspergillus. There were significant changes in the pattern of opportunistic infections between the 2 time periods. Mycobacterial infections decreased considerably in the HIV group (17.9 vs. 8.5%, P=0.02), while the incidence of P. jiroveci decreased mainly in the transplant group (32.6 vs. 7.9%, P<0.00001). This study demonstrates a changed pattern of pulmonary infections in immunocompromised patients diagnosed by BAL. The overall diagnostic yield of BAL remains high in immunocompromised patients with respiratory symptoms.

Demographic and Clinical Characteristics of HIV-Infected Inpatients and Outpatients at a Cambodian Hospital

A retrospective cross-sectional survey of 299 HIV-infected inpatients and outpatients was conducted between March 1999 and June 2000 in Phnom Penh, Cambodia, to define patient demographics and risk factors for HIV-1 infection, and to compare whether symptoms and opportunistic infections (OIs) differ by gender and site of patient care. The population represented one third of HIV-infected patients regularly receiving care at the Sihanouk Hospital Center of HOPE. Over one quarter (26%) of the men were soldiers and 27% were farmers or laborers. Eighty-nine percent of the men had visited sex workers, 29% of men and women had unsafe injections in the past, and 18% of women reported a spouse who was HIV-positive. Eighty percent of patients presented with weight loss more than 10% from baseline. Seventy-two percent of patients were diagnosed with two or more concurrent OIs or conditions. Oral candidiasis (p = <0.001), abdominal lymphadenitis (p = 0.03), and two or more concurrent OIs (p = <0.001) were diagnosed more often among men than women. Multivariate logistic regression shows that patients who presented with weight loss more than 10% from baseline are more likely to have one or more OIs or conditions. The results of this survey suggest that the primary risk factor for HIV-infected men presenting to this care facility was visiting sex workers. The pattern of OIs and other HIV-associated conditions indicated that the majority of patients delayed seeking care at the hospital. HIV physicians in Cambodia should be aware of the likelihood for multiple OIs or conditions when patients present weight loss more than 10% from baseline.

Women in the HIV Epidemic

In the United States, the majority of women with HIV/AIDS are women whose lives have been touched by injection drug use--their own or that of their sexual partners. The pattern of opportunistic infections in women is more similar to that of injection drug users than that of homosexual men. Specific complications associated with a woman's reproductive tract include persistent Candida vaginitis, human papillomavirus infections, cervical dysplasias, and, possibly, pelvic inflammatory disease. Childbearing decisions for women with HIV infection are complex and culturally mediated. Meeting the challenge of providing high quality services to women with HIV infection requires major changes in the service delivery system.