Presence Of HIV Infection Research Articles

Burden of Tuberculosis in End Stage Renal Disease Patients Undergoing Maintenance Hemodialysis: A Multicenter Study and Experience from Ethiopian Dialysis Setting.

Patients with end stage renal disease (ESRD) are at a higher risk of developing tuberculosis (TB) due to the immunosuppressed state along with concomitant comorbidities and socioeconomic and demographic factors. Data on the prevalence of tuberculosis in ESRD are scarce despite the high burden of the disease in developing nations. A multicenter, cross-sectional study was conducted at eight dialysis centers in Addis Ababa on the prevalence of TB among CKD patients on maintenance hemodialysis from August 2022 to October 2022 G.C. The study enrolled 263 participants selected by systematic random sampling. Data were collected by reviewing the patient's electronic medical records. The Collected data were analyzed using SPSS version 26.0. Our study found a 27% prevalence of TB in patients with ESRD receiving maintenance hemodialysis (MHD). Pulmonary tuberculosis was the most prevalent form, and lymphadenitis was the most common extra-pulmonary tuberculosis (EPTB). Only 5.6% of the study participants had microbiologic evidence of TB. Chemistry and cytological studies from pleural fluid and imaging evidences were commonly used diagnostic modalities. The presence of HIV infection, longer duration of dialysis (>1 year), and contact history with a known TB patient were all significantly associated with higher prevalence of TB among the study participants. Although there is a strong association between TB and CKD, there are no local data from Ethiopia. Our study identified a higher prevalence of TB among CKD patients on MHD. Thus, maintaining a high index of suspicion and early diagnosis and treatment of TB among ESRD patients on MHD and use of TB preventive therapy (TPT) is important in decreasing morbidity and mortality.

Применение полуколичественного экспресс-теста на прокальцитонин в диагностике внебольничной пневмонии у пациентов с ВИЧ-инфекцией

Timely diagnosis of community-acquired pneumonia (CAP) and optimal timing of initiation of antibiotic therapy are important for reducing mortality in patients with HIV infection. It is reported that the assessment of procalcitonin (PCT) levels in this category of patients can be a useful diagnostic tool. Aim. To determine the levels of a new semi-quantitative rapid test (RT) for PCT in patients with CAP depending on the presence or absence of HIV infection. Design. Cross-sectional comparative study. Material and methods. The study involved 123 patients hospitalized with a diagnosis of CAP. 15 (12.2%) patients, including 10 (66.7%) men and 5 (33.3%) women (average age 59.3 ± 22.4 years), were diagnosed with HIV infection 3th stage. The comparison group included 108 people (48 (44.4%) men and 60 (55.6%) women, average age 48.1 ± 20.5 years) who did not have HIV infection. Before starting antibacterial therapy, all patients underwent a general clinical examination, the concentration of PCT in plasma was determined quantitatively using the enzyme-linked immunosorbent assay, as well as using a new semi-quantitative ET method using a one-step immunochromatographic analysis. Results. In the group of patients with CAP without HIV infection, borderline values of PCT ET (0.5 to < 2 ng/ml) were encountered 3.3 times more often than in patients with concomitant HIV infection (0.5 to < 2 ng/ml) — 22.2% versus 6.7 %; p = 0.030. High levels of PCT ET (from 2 to <10 ng/ml) were 7 times more likely to be detected in patients with CAP and HIV infection than without it - 13.3% versus 1.9%; p = 0.030. The quantitative content of PCT in the blood was also 4.5 times higher in patients with CAP in the presence of HIV infection (0.49 [0.11; 0.76] and 0.11 [0.01; 0.52] ng/ml; p = 0.038) relative to the comparison group. In the group of patients with CAP and HIV infection, a positive correlation was established between PCT RT and the degree of respiratory failure (r = 0.656; p = 0.008) and quantitative PCT (r = 0,453; р = 0,048), test negative correlations with the content of platelets (r = –0.542; p = 0.037), sodium (r = –0.700; p = 0.016 ) and saturation level (r = 0.335; p = 0.022). Conclusion. Patients with CAP and HIV infection in comparison with persons without HIV infection are characterized by higher PCT values determined by both classical quantitative and new semi-quantitative RT, which makes it possible to use the latter for rapid diagnosis of CAP in this group of patients. Key words: community-acquired pneumonia, HIV infection, diagnostics, procalcitonin, procalcitonin rapid test

Experience in the treatment of Hodgkin’s lymphoma associated with HIV

Background. Among malignant neoplasms in HIV-infected patients lymphomas occupy a special place due to the high incidence, course characteristics, and difficulties that arise during diagnosis and during antitumor drug therapy. Hodgkin’s lymphoma (HL) is not an AIDS indicating disease, but the risk of its development in people infected with HIV is 5–25 times higher than the incidence of HL in the general population. Prior to the use of antiretroviral therapy, the results of standard chemotherapy in HIV-infected patients with HL were significantly worse than in HIV-negative patients. One of the main requirements for drug treatment of this group of patients is the simultaneous use of antiretroviral therapy and chemotherapy. The aim was to study the clinical characteristics and results of treatment of HL in the presence of HIV infection. Materials and methods. The analysis included 24 HL patients with HIV infection who received treatment in the Department of Radiation and Drug Therapy of Hemoblastoses of the MRRC in the period from 2018 to 2022. Treatment program selection was in accordance with the HL treatment protocol developed at our Center. Patients received 4–6 cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) or 6 cycles of BEACORP (bleomycin, vepesid, doxorubicin, cyclophosphamide, vincristine, dacarbazine, prednisolone) chemotherapy according to the stage of the disease and the risk factors generally accepted for patients with HL. The response to therapy was assessed according to the Lugano-2014 criteria. Descriptive statistics methods were used. Overall survival and progression-free survival were analyzed using the Kaplan-Meier method. Results. HL occurring against the background of HIV is most often represented by a widespread nodal and extranodal lesion, accompanied by symptoms of intoxication (B-symptoms). The use of standard CT regimens as induction therapy for HL in the presence of HIV makes it possible to obtain satisfactory immediate and long-term results of treatment. In our study complete and partial responses were achieved in 94.1 %. With a median follow-up of 12 months survival without progression and overall survival were 75 % and 100 % respectively.

Prevalence of HPV infection and cervical intraepithelial lesions in HIV positive and negative women in the city of Florianopolis

Introduction: The human papillomavirus (HPV) is the most common sexually transmitted infection among women. The HPV of high oncogenic risk, associated with other factors, presents a risk of progressing to a precancerous lesion of the uterus and even cancer. Such an evolution is related to the persistence of the infection and other factors, mainly those that interfere with women’s immunity. The immunosuppression caused by HIV infection is an important factor for viral persistence and the onset of these lesions. Objectives: To compare the prevalence of HPV infection and cervical intraepithelial lesions in HIV-positive and negative women and describe the possible associated risk factors. Methods: The sample consisted of 50 HIV positive women (study group) and 50 HIV negative women (control group) recruited from the public health system of Florianópolis from January to April 2022. Cervical samples were collected for cytological analysis and for the detection of high-risk oncogenic HPV DNA by polymerase chain reaction (PCR). Categorical variables were compared using the chi-square test, with a significance level set at 5% Results: HPV infection was more prevalent in the control group; however, HIV positive women presented higher frequency of intraepithelial lesions diagnosed on cytology. Factors such as higher number of sexual partners, depression and smoking were more frequent in the group of HIV positive women. CD4 T cells lower than 200 cells/mm3 was associated with a higher number of altered Pap smears and a positive HPV DNA test. The use of combination antiretroviral therapy and undetectable viral load were associated with more frequent normal cytology and undetected HPV DNA. Conclusion: The prevalence of cervical intraepithelial lesions in HIV-infected women is higher than among women without the infection. The presence of HIV infection was the most important risk factor associated with the development of cervical lesions.

Сочетанное поражение легких у больных в эпидемию коронавирусной инфекции CОVID-19 в условиях противотуберкулезного диспансера

Diagnosis of lung diseases is difficult, especially during an epidemic, with a large number of patients and a limited time for diagnosis. The purpose — to evaluate the results of differential diagnosis of lung diseases and the outcome of the disease in patients with suspected coronavirus pneumonia COVID-19 and pulmonary tuberculosis. Material and methods. We analyzed 705 records of patients admitted to the Tuberculosis Dispensary with suspected tuberculosis and coronavirus pneumonia during the COVID-19 pandemic. Results. It is difficult to establish the disease etiology by evaluating complaints and X-ray, especially against the background of HIV infection. We assessed the proportion of isolated viral pneumonia, bacterial-viral pneumonia, combination of viral pneumonia with pulmonary tuberculosis, both with and without the presence of HIV infection. Evaluation of the immune status of patients with HIV infection and laboratory diagnostics made it possible to suspect and identify pneumocystosis of the lungs. The outcome in each category of patients was analyzed. Significant criteria for the development of an unfavorable outcome of coronavirus pneumonia were obtained. Conclusion. Each patient with a suspected diagnosis of pneumonia needs high-quality and timely diagnostics to verify the infectious agent of the lungs and assess the patient’s HIV status.

Using genetic data to identify transmission risk factors: Statistical assessment and application to tuberculosis transmission.

Identifying host factors that influence infectious disease transmission is an important step toward developing interventions to reduce disease incidence. Recent advances in methods for reconstructing infectious disease transmission events using pathogen genomic and epidemiological data open the door for investigation of host factors that affect onward transmission. While most transmission reconstruction methods are designed to work with densely sampled outbreaks, these methods are making their way into surveillance studies, where the fraction of sampled cases with sequenced pathogens could be relatively low. Surveillance studies that use transmission event reconstruction then use the reconstructed events as response variables (i.e., infection source status of each sampled case) and use host characteristics as predictors (e.g., presence of HIV infection) in regression models. We use simulations to study estimation of the effect of a host factor on probability of being an infection source via this multi-step inferential procedure. Using TransPhylo-a widely-used method for Bayesian estimation of infectious disease transmission events-and logistic regression, we find that low sensitivity of identifying infection sources leads to dilution of the signal, biasing logistic regression coefficients toward zero. We show that increasing the proportion of sampled cases improves sensitivity and some, but not all properties of the logistic regression inference. Application of these approaches to real world data from a population-based TB study in Botswana fails to detect an association between HIV infection and probability of being a TB infection source. We conclude that application of a pipeline, where one first uses TransPhylo and sparsely sampled surveillance data to infer transmission events and then estimates effects of host characteristics on probabilities of these events, should be accompanied by a realistic simulation study to better understand biases stemming from imprecise transmission event inference.

HUMAN IMMUNODEFICIENCY VIRUS (HIV) AND ITS ASSOCIATION WITH HEMATOLOGICAL PARAMETERS

Background: Hematological derangements are among the common complications associated with HIV infection. HIV infection may affect any cell line causing, anemia, thrombocytopenia, and leucopenia or may cause pancytopenia.Patients and Materials: This study was conducted at a tertiary care hospital from March 2020 to June 2020. Patients were diagnosed as HIV positive as per WHO criteria. Detailed medical history, physical examination, and investigations were conducted. Data was collected and analyzed on SPSS version 21.0.Results: Total 92 patients were selected for the study. Patients were divided into two groups. Group A consists of 48 control patients. Group B consists of 44 HIV – positive patients. Majority of patients belonged to reproductive age group (16 – 45 years) in both groups. Male to female ratio was higher (4:1) in both groups. Common clinical features among patients were fever (85%), weight loss (73%), anemia (35%) and oral thrush (19%) in Group B.Conclusion: Hematological abnormalities were present in presence of HIV infection as compared to control group. This may has significant effect on clinical outcome of the disease. So all the HIV- positive patients should be investigated for routine hematological evaluation.

Sectional detection of pathological processes of the female reproductive system in the presence of immunodeficiency states

The presence of an immunodeficient state in women of reproductive age can lead to the development of comorbid pathology, including in the female reproductive system. Given the fairly frequent antisocial behavior of such women, timely diagnosis and early detection of lesions are not always possible or have significant drawbacks. Given the fairly frequent antisocial behavior of such women, timely diagnosis and early detection of lesions are not always possible or have significant disadvantages. Therefore, we set a goal to investigate how different the detection of pathological conditions of the female reproductive system is in the presence of HIV infection, chronic alcoholism, their simultaneous presence and their absence based on the results of cross-sectional studies. Autopsies of women with immunodeficiency of infectious and non-infectious origin were analyzed. According to the results, it was established that the presence of HIV infection, chronic alcoholism, and their combination is characterized by a more frequent development of pathological processes of an infectious nature, non-plastic remodeling, and non-specific inflammatory processes in the organs of the female reproductive system. Thus, it should be determined that female genital system requires close vigilance in the presence of immunodeficiency, taking into account the prevalence of this problem and its consequences. Keywords: HIV-infection, cervix, autopsy, opportunistic infection, tuberculosis.

Dopamine‐driven Increase in IL‐1β in Myeloid Cells is Mediated by Differential Dopamine Receptor Expression and Exacerbated by HIV

The neurological complications of HIV infection, known as neuroHIV, remain prevalent even in individuals on antiretroviral therapy (ART). Although the mechanism(s) underlying neuroHIV remain undefined, current data suggest that neuroinflammation is central to the development of HIV neuropathogenesis. Neuroinflammation can be exacerbated by substance use disorders, which are highly comorbid with HIV infection and substantively worsen clinical outcomes. Despite distinct mechanisms of action, all substances of abuse increase central nervous system (CNS) dopamine, suggesting that dopamine is a common mechanism by which addictive drugs potentiate neuroHIV. Our published data show that dopamine increases the production of inflammatory cytokines such as IL‐1β in human microglia and macrophages, but the mechanisms by which dopamine drives inflammation are not clear. Studies indicate that D1‐like dopamine receptors (DRD1, DRD5) mediate inflammatory activity while D2‐like dopamine receptors (DRD2, DRD3, and DRD4) mediate anti‐inflammatory activity, and we have shown that human macrophages and microglia have higher expression of D1‐like receptors. Therefore, we hypothesize that dopamine‐mediated production of IL‐1β in CNS myeloid cells is regulated by the ratio of different dopamine receptor expression levels and can be exacerbated by HIV infection. Our data in primary macrophages indicate that DRD1 expression is necessary for dopamine‐mediated increases in IL‐1β, but that changes in DRD2 expression can alter the magnitude of the dopamine‐mediated increase in IL‐1β. We confirm this in human microglia cell lines, showing that dopamine only increases IL‐1β gene and protein expression in microglia with a high ratio of D1‐like receptors to D2‐like receptors. Further, antagonizing dopamine receptor expression with the pan‐dopamine receptor antagonist flupentixol or decreasing the D1‐like/D2‐like ratio by overexpressing DRD2 diminishes the dopamine‐mediated increase of IL‐1β. We also show that the effects of dopamine on IL‐1β are potentiated in the presence of HIV infection in both microglial cell lines and iPSC‐derived microglia. Ongoing studies are examining the role of epigenetic regulation in the effects of dopamine and HIV on inflammation in these myeloid systems.Due to the prevalence of both substance use disorders and the increasing use of dopamine‐modulating therapeutics, a detailed understanding of dopamine‐mediated changes in inflammation will be critical to effectively tailor ART regimens to HIV‐infected individuals using these drugs.

Dopamine May Exacerbate Neuroinflammation in the Context of HIV by Driving Inflammatory Phenotypes in Macrophages

Globally, there are around 38 million people living with HIV (PLWH). Treatment with anti‐retroviral therapy (ART) can suppress HIV replication and improve the length and quality of life, but chronic infection and ART treatment has resulted in the development of a variety of new co‐morbidities. Among these are the constellation of neuropathological, behavioral, cognitive and motor symptoms collectively known as neuroHIV. These symptoms are found in approximately 50% of the infected population, and multiple lines of evidence indicate that neuroHIV is primarily mediated by chronic CNS infection and inflammatory response in CNS myeloid populations such as macrophages and microglia. In many PLWH, these inflammatory conditions can be exacerbated by substance use disorders, which are highly comorbid with HIV infection and disproportionately common in HIV‐infected populations. Substance use disorders of all types are a major risk factor for the development of neuroHIV, suggesting a common mechanism by which substances of abuse interact with HIV to promote inflammation. All addictive substances increase extracellular dopamine in the CNS and our previous data show that dopamine promotes an inflammatory phenotype in human macrophages. Thus, we hypothesize that exposure to dopamine concentrations (10‐6M) induced by stimulant use will more robustly increase inflammation in HIV‐infected human monocyte‐derived macrophages (MDM) than in uninfected MDM. To test this, uninfected and HIV‐infected human MDM were treated with dopamine and changes in inflammatory profiles were assessed by measuring NF‐κB nuclear translocation using high content imaging and quantifying cytokine production by AlphaLISA analysis. Dopamine significantly increased the production of the inflammatory cytokines IL‐6 and IL‐1β, and these were specifically mediated via dopamine receptors and the activation of NF‐κB. These findings correlate with expression of dopaminergic receptors and nod‐like receptor (NLR) inflammasome transcripts and were altered in the presence of HIV infection. We also found that baseline macrophage activation could be attributed to culture medium type. Overall, these studies provide a broader understanding of the immunological role of dopamine, particularly in the development of neuroHIV and may suggest a potential mechanism for further pharmacological investigation to target HIV infection.

An Optimal Control Strategy for Antiretroviral Treatment of HIV Infection in Presence of Immunotherapy

An Optimal Control Strategy for Antiretroviral Treatment of HIV Infection in Presence of Immunotherapy

Incidence and risk factors of extrahepatic manifestations in patients with chronic HCV and HCV/HIV infection

Purpose. To study the incidence and risk factors for the development of extrahepatic manifestations like arthralgias, cutaneous manifestations of vasculitis, polyneuropathy, xerophthalmia, Raynaud’s syndrome, chronic kidney disease (CKD) in patients with chronic HCV infection, and HCV/HIV co-infection.Materials and methods. The cohort study included 331 patients: 254 people with HCV, 77 — with HCV/HIV.Results. Extrahepatic manifestations were detected in 50% of HCV patients and 70% of HCV/HIV patients (p=0,002). Among patients with HCV and HCV/HIV the most common were joint lesions (42% vs 46%, p=0,563), skin rashes (20% vs 25%, p=0,345), polyneuropathy (13% vs 17%, p=0,441), CKD (11% vs 35%, p<0,001), less often Raynaud’s syndrome (3% vs 8%, p=0,076) and xerophthalmia (5% vs 4%, p=0,661). The logistic regression model revealed a significant relationship between the development of one or more extrahepatic manifestations in patients with chronic HCV infection with cryoglobulinemia (p<0,001), the presence of HIV infection (p<0,001), and age (p=0,007). However, logistic regression models tested for each of the studied manifestations revealed a significant effect of HIV infection only on the development of CKD (p<0,001), while cryoglobulinemia possessed significant risk factors for each of the manifestations, except xerophthalmia. Conclusion. The data obtained indicate a high incidence of extrahepatic manifestations in patients with chronic HCV and HCV/HIV infection, also a significant role of HIV co-infection for the development of CKD, and the role of cryoglobulinemia in the development of extrahepatic manifestations, except xerophthalmia.

Prevalence of substance abuse, violence, HIV/AIDS (SAVA) syndrome among injecting drug users in six cities of Russian Federation

Study of the peculiarity of HIV spread, first of all in the cities led to the formulation of syndemic concept — mutually enhancing set of social, behavioral and biological characteristics of which most frequently mentioned is a combination of substance abuse, victimization (experience of violence) and presence of HIV-infection or AIDS (SAVA syndrome). The prevalence of this syndemic is not studied in detail in Russian Federation.The goal of the present study was to evaluate the prevalence of this syndrome and its components among injecting drug users in six cities in the Russian Federation.Results and discussion. The summary prevalence of the full SAVA was 12,3% (95% CI=10,0–14,.6%), but there were significant differences between cities especially between St. Petersburg and Krasnoyarsk (18,9% vs 6,7%, р=0,031). Prevalence of incomplete SAVA syndrome (without the mandatory presence of HIV/AIDS) was 66,0% (95% CI=62,4–69,6%) the and majority of respondents (96,8%) had up to 4 SAVA components. There were no statistically significant differences in SAVA prevalence depending on gender. SAVA is relatively highly prevalent among IDU in participating cities and does not relate to respondents’ gender.

Evaluation of platelet parameters in cerebral stroke in patients with HIV infection

The article reflects the results of studying platelet parameters in HIV-positive patients with different types of stroke.Aim. To identify changes in laboratory parameters of a complete blood count which characterize the morphofunctional features of platelets in stroke among HIV-positive patients.Materials and methods. 110 HIV-positive patients who received treatment for stroke in hospitals of the Tyumen region were examined. The study of blood parameters was carried out at the analyzer Sysmex XE2100 (Japan). Blood sampling was carried out on the day of patients admission.The number of platelets and platelet indices were analyzed: MPV – mean platelet volume, PDW – platelet distribution width, PCT – plateletcrit and P-LCR – platelet large cell ratio. The control group consisted of 117 patients. The signifcance of the differences was determined at the twotailed signifcance level of p < 0.05.Results. There was a signifcant decrease in the number of platelets (p < 0.05), in average, on 34.3% among patients with hemorrhages and HIV infection. Among patients with ischemic stroke this decrease was less pronounced (p = 0.05). A signifcant decrease in plateletcrit was established among patients with intracranial hemorrhages, while it did not change signifcantly among patients with cerebral infarction. During evaluation of other platelet parameters, no signifcant differences were found between patients in experimental and control groups. The coeffcient of giant platelets prevailed by one and a half times in patients with hemorrhages associated with HIV infection, which turned out to be beyond the statistical signifcance.Conclusion. The presence of HIV infection leads to a more pronounced, reliable decrease in the number of platelets and plateletcrit among patients that have acute phase of the development of hemorrhagic stroke than in patients with cerebral infarction. The development of intracranial hemorrhage among HIV-positive patients is characterized by an increase of blood platelets with a high volume, the level of which increased by one and a half times being beyond the statistical signifcance and having as a leading mechanism the intensifcation of platelet formation in the bone marrow.

ВОЗМОЖНЫЕ ПРИЧИНЫ ФОРМИРОВАНИЯ РЕЦИДИВОВ ТУБЕРКУЛЕЗА У ДЕТЕЙ В СОВРЕМЕННЫХ УСЛОВИЯХ: КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯ

The epidemiological situation of tuberculosis (TB) has been improving steadily in recent years however, in the structure of TB patients, there is a high proportion of patients with multidrugresistant/extensively drug-resistant (XDR) pathogens and people with HIV and TB co-infection. As a result, cases of TB disease in children with many risk factors for unfavorable outcome of therapy are recorded, leading to subsequent relapse. the aim of the work was to analyze possible causes of formation and structure of clinical forms of recurrence of TB in children. A retrospective analysis of outpatient cards and medical records of children of residents of the Leningrad region, who had a TB relapse, was carried out. It has been established that in Leningrad Oblast, there were 3 cases of recidivism of TB among children registered from 2011 to 2020. The main risk factor for the development of primary TB was the lack of immunization against TB due to perinatal contact with an HIV-infected mother. The provoking factors of TB relapse were the occurrence of exogenous superinfection of TB, the presence of HIV infection in the child, the presence of large residual changes after primary TB, close contact with a TB patient with an XDR of the causative agent.

The Role of HIV Infection in the Pathophysiology of Gestational Diabetes Mellitus and Hypertensive Disorders of Pregnancy.

Purpose of the Review: The main objective of this study is to investigate mechanisms associated with gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) in HIV infected pregnant women by looking how placental hormones such as (progesterone and prolactin) and basic haemostatic parameters are regulated in HIV infected pregnancies.Recent Findings: HIV/AIDS are a major global obstetric health burden that lead to increased rate of morbidity and mortality. HIV/AIDS has been associated with the pathophysiology of GDM and HDP. Increased risk of GDM due to highly active antiretroviral therapy (HAART) usage has been reported in HIV infected pregnancies, which causes insulin resistance in both pregnant and non-pregnant individuals. HAART is a medication used for lowering maternal antepartum viral load and pre-exposure and post-exposure prophylaxis of the infant. In pregnant women, HAART induces diabetogenic effect by causing dysregulation of placental hormones such as (progesterone and prolactin) and predispose HIV infected women to GDM. In addition to HIV/AIDS and GDM, Studies have indicated that HIV infection causes haemostatic abnormalities such as hematological disorder, deregulated haematopoiesis process and the coagulation process which results in HDP.Summary: This study will help on improving therapeutic management and understanding of the pathophysiology of GDM and HDP in the absence as well as in the presence of HIV infection by reviewing studies reporting on these mechanism.

Recurrent Herpes Zoster as a Sign of HIV Infection

Herpes Zoster is characterized with painful dermatomal blisters, which commonly seen in elderly or immuncompromised people. It is caused by varicella zoster virüs (VZV). HIV infection is known as a risk factor for herpes zoster and for developments of its complications. Cutaneous findings can be the presenting symptom for HIV infection. In the presence of HIV infection, HZ can be prolong or can complicate evet its recurrence rate increases. HZ recurrences are usually seen in immuncompromised individuals. In the presence of HIV infection, the risk of HZ increases up to 12-17 fold. Prophylaxis with daily asiclovir decrease the risk of HZ by 68%. Vaccination for HZ was found safe and effective in HIV patients with CD4+ cell count more than 200 cells/. Skin findings are frequent in HIV patients and its diversity change according to the stages of the disease. Here we report a case of recurrent HZ which later diagnosed with positive for HIV, therefore, to mention HIV as a risk factor in cases of recurrent HZ.

White matter of perinatally HIV infected older youths shows low frequency fluctuations that may reflect glial cycling

In perinatally HIV-infected (PHIV) children, neurodevelopment occurs in the presence of HIV-infection, and even with combination antiretroviral therapy (cART) the brain can be a reservoir for latent HIV. Consequently, patients often demonstrate long-term cognitive deficits and developmental delay, which may be reflected in altered functional brain activity. Our objective was to examine brain function in PHIV on cART by quantifying the amplitude of low frequency fluctuations (ALFF) and regional homogeneity (ReHo). Further, we studied ALFF and ReHo changes with neuropsychological performance and measures of immune health including CD4 count and viral loads in the HIV-infected youths. We found higher ALFF and ReHo in cerebral white matter in the medial orbital lobe for PHIV (N = 11, age mean ± sd = 22.5 ± 2.9 years) compared to controls (N = 16, age = 22.5 ± 3.0 years), with age and gender as co-variates. Bilateral cerebral white matter showed increased spontaneous regional activity in PHIV compared to healthy controls. No brain regions showed lower ALFF or ReHo in PHIV compared to controls. Higher log10 viral load was associated with higher ALFF and ReHo in PHIV in bilateral cerebral white matter and right cerebral white matter respectively after masking the outcomes intrinsic to the brain regions that showed significantly higher ALFF and ReHo in the PHIV compared to the control. Reductions in social cognition and abstract thinking in PHIV were correlated with higher ALFF at the left cerebral white matter in the left medial orbital gyrus and higher ReHo at the right cerebral white matter in the PHIV patients. Although neuroinflammation and associated neuro repair were not directly measured, the findings support their potential role in PHIV impacting neurodevelopment and cognition.

Surgical treatment of an aortic root abscess in a patient with HIV / AIDS

The successful surgical treatment of infectious endocarditis with abscess of the aortic root in a patient with HIV infection and immunodeficiency is presented in this clinical case study. The paper discusses the tactical aspects of the technique of surgical intervention and management features associated with the presence of HIV infection. In patients with HIV-related immunosuppression, similar to other patients with infectious aortic valve endocarditis with aortic root destruction, the method of choice is an early surgical treatment with radical debridement and subsequent reconstruction of the aortic root. The type of reconstruction depends on the degree of destruction. Choice of valves does not significantly impact survival, freedom from recurrence of endocarditis or reoperation due to reinfection. Preventive implantation of epicardial electrodes with a formed or complete atrioventricular block is not advisable due to the high risk of secondary infection of the endocardial electrodes and persistence of sepsis.Received 30 April 2020. Revised 13 July 2020. Accepted 28 July 2020.Conflict of interest: Authors declare no conflicts of interest.Funding: The study did not have sponsorship.

Activity of matrix proteinases and their inhibitors in patients with thoracic aortic dissection

Purpose. To study changes in profibrogenic mediators in patients with thoracic aortic dissection.Material and methods. The study was carried out in 66 patients with dissection of the ascending aneurysm and the aortic arch, which occurred against the background of atherosclerosis and hypertension, aged 48 to 73 years. According to the objectives of the study, the patients were divided into three groups: the first – 32 patients with acute dissections, the second – 34 patients with subacute and chronic dissections, the third – 30 patients with aneurysms of the thoracic and abdominal aorta, who were diagnosed during a routine examination. The control was the results of laboratory studies obtained in 28 healthy volunteers. The study groups were randomized according to the main clinical criteria and the severity of the condition (χ2 = 0.901, p = 1.000). The standard of laboratory tests included a clinical and biochemical blood test, a blood test for troponin I, a blood clotting test, a general urine test, and the calculation of GFR. Determined the blood group, Rh factor. On a mandatory basis, the patients were examined for the presence of the Australian antigen, antibodies to viral hepatitis "C", the Wasserman reaction was performed, and the presence of HIV infection was examined. Determination of the level of MMP-9, its inhibitor TIMP-2 and a complex with an inhibitor (MMP-9/TIMP-2) in the blood serum were investigated using commercial diagnostic kits from R&D Diagnostics Inc. (USA): Human MMP-9 Quantikine ELISA Kit, Cat.GA30092; Human ТІМP-2 Quantikine ELISA Kit, Cat. BE69073). Statistical analysis of the data obtained was carried out on an IBM PC Intel Core i5-6500U personal computer with MS Windows 10 using the STATISTICA 10.0 program (StatSoft, Inc.).Results. In all types of aortic aneurysms (uncomplicated and complicated), an increase in the level of MMP-9 was noted concerning the control values: in patients of the 1st group, the level of MMP-9 was increased on average by 284.5%, in the 2nd group - by 176, 9% and in patients with uncomplicated aneurysms - by 91.7%, respectively, to the control values (p <0.05). At the same time, the level of MMP-2 was increased in all the studied groups but did not differ significantly between the groups (p = 0.37). The concentration of tissue inhibitor of matrix metalloproteinases (TIMP-2) in patients with acute dissection of the aortic aneurysm was on average 40.4% higher than the control values (p <0.001); in patients with chronic dissection of the aneurysm, the differences were insignificant; and in patients with uncomplicated aortic aneurysms, the level of TIMP-2 was, on average, 12% lower than that obtained in the control group (p <0.05). With a confidence level of 0.95% (p <0.05), the MMP-9 index significantly differed in all three groups. The MMP-9/TIMP-2 coefficient (inhibition coefficient according to MMP-9) was higher in patients with complicated aneurysms and amounted to 0.67, respectively (in the control – 0.25) (p <0.001). In patients with uncomplicated aneurysms, this integral indicator was lower than in the first two groups but exceeded the indicators of the control group by 112% (p <0.001). With the progression of degenerative changes in the middle lining of the vessel, MMP-9 and TIMP-2 decreased compared with patients with uncomplicated aneurysm and chronic dissection.Conclusions. Severe course of acute aortic dissection is associated with the presence of high MMP-9 levels, while SMC disorders occur against the background of oxidative stress and an imbalance between pro-inflammatory and anti-inflammatory cytokines are associated with inhibition of TIMP-2. In various types of complicated aortic aneurysms, there is an imbalance of MMP and their inhibitors, which affect the rate of proteolysis of extracellular matrix components with a predominance of the processes of their formation and accumulation.