Presence Of Human Immunodeficiency Virus Infection Research Articles

Prevalence of HIV in people with potential HIV-indicator conditions in Germany: an analysis of data from statutory health insurances

In care of people living with human immunodeficiency virus (HIV), early diagnosis of infection is one of the greatest challenges remaining. A promising approach to increase early diagnosis could be optimized HIV testing in persons with indicator conditions (ICs). ICs are conditions which are AIDS-defining in people living with HIV, conditions that may have significant adverse consequences for the individual's clinical management if the presence of HIV infection is not detected, and conditions with an (undiagnosed) HIV prevalence of ≥0.1%. In this cohort study, anonymous routine healthcare data of German statutory health insurances from 07/01/2016 to 06/30/2021 based on insured persons with an ICD-10-based diagnosis of selected ICs were analyzed. In a primary analysis, two stratifications (gender and age), and four sensitivity analyses HIV prevalence/incidence were calculated for persons with at least one of 26 IC described in international literature. This study is registered in the German Clinical Trials Register (identifier: DRKS0002874). Routine healthcare data from 513,509 insured persons were selected for analysis. In the primary analysis, only in malignant neoplasm of bronchus and lung a HIV prevalence was observed with a 95%-CI < 0.1%. ICs with particularly high HIV prevalence were pneumocystosis (40.33%), oral hairy leukoplakia (36.71%), and Kaposi's sarcoma (29.86%). When stratified by gender, it was observed that in female patients, the 95%-CI of HIV prevalence fell below 0.1% for seven ICs. No such effect was observed in male patients. Stratified by age, among patients aged 30 to <60 years, the 95%-CI of HIV prevalence were always ≥0.1%, while in the other groups the 95%-CI fell below 0.1% for several ICs. In samples of patients with ICs in Germany, HIV prevalences/incidences were found to be ≥0.1% for all ICs except malignant neoplasm of bronchus and lung. This confirms the classification of these conditions as ICs for the German context and emphasizes the importance of HIV testing in these populations. This analysis is part of the HIV testing recommendations in guidelines and practice study (German title of the study: "HIV-Testempfehlungen in Leitlinien und Praxis"; acronym: HeLP), which is funded by the German Federal Joint Committee as part of the Innovationsfonds program to further develop the German healthcare system (funding number 01VSF21050).

Expression of CYP2B6 Enzyme in Human Liver Tissue of HIV and HCV Patients.

Background and Objectives: Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections present significant public health challenges worldwide. The management of these infections is complicated by the need for antiviral and antiretroviral therapies, which are influenced by drug metabolism mediated by metabolic enzymes and transporters. This study focuses on the gene expression of CYP2B6, CYP3A4, and ABCB1 transporters in patients with HIV, HCV, and HIV/HCV co-infection, aiming to assess their potential association with the choice of therapy, patohistological and clinical parameters of liver damage such as the stage of liver fibrosis, serum levels of ALT and AST, as well as the grade of liver inflammation and other available biochemical parameters. Materials and Methods: The study included 54 patients who underwent liver biopsy, divided into HIV-infected, HCV-infected, and co-infected groups. The mRNA levels of CYP2B6, CYP3A4, and ABCB1 was quantified and compared between the groups, along with the analysis of liver fibrosis and inflammation levels. Results: The results indicated a significant increase in CYP2B6 mRNA levels in co-infected patients, a significant association with the presence of HIV infection with an increase in CYP3A4 mRNA levels. A trend towards downregulation of ABCB1 expression was observed in patients using lamivudine. Conclusions: This study provides insight into gene expression of CYP2B6 CYP3A4, and ABCB1 in HIV, HCV, and HIV/HCV co-infected patients. The absence of correlation with liver damage, inflammation, and specific treatment interventions emphasises the need for additional research to elucidate the complex interplay between gene expression, viral co-infection, liver pathology, and therapeutic responses in these particular patients population.

Analysis of mortality and risk of death in HCV- and HCV/HIV-infected patients with extrahepatic manifestations

The aim of the study was to analyze the mortality of patients infected with the hepatitis C virus (HCV) and co-infected with the human immunodeficiency virus (HIV) with extrahepatic manifestations associated with cryoglobulinemia, and to assess the dependence of the risk of fatal outcome on such predictors as the presence of HIV infection, the presence of cirrhotic liver transformation, antiviral therapy (AVT) of chronic hepatitis C, cryoglobulin levels.Materials and Methods. The prospective study included 125 patients with HCV (n=92) and HCV/HIV infection (n=33) who had extrahepatic manifestations (arthralgia and/or skin hemorrhagic rashes and/or polyneuropathy and/or or Raynaud’s syndrome and/or xerophthalmia and/ or chronic kidney disease), as well as cryoglobulins.Results. 19 out of 125 patients (15% (95% CI 10-23%)) died in the follow-up period from 1 to 170 months (median 57 months), among which 12 people did not receive AVT for HCV infection during the follow-up period and 7 patients underwent AVT during the observation period. Unadjusted mortality among patients treated with AVT was 9% (95% CI 5–18%) (n=7/77), those who did not receive it was 25% (95% CI 15–39%) (n=12/48), χ2=5,806, p=0,016. Cox regression analysis showed that an increase in the risk of death is associated with the presence of cirrhotic liver transformation by 5,3 times and the absence of AVT by 3,7 times. The main causes of death in 69% of cases were causes not associated with liver pathology, in 26% were complications of liver cirrhosis (bleeding or progressive encephalopathy), in one case (5%) the cause of death remained unknown.Conclusions. Мortality among patients with HCV or HCV/HIV infection complicated by the development of extrahepatic manifestations associated with cryoglobulinemia is higher in the absence of AVT than in the case of AVT. Cirrhotic liver transformation and the absence of AVT significantly affect the risk of death. Patients with extrahepatic manifestations die mainly from causes not associated with liver pathology.

Epidermal barrier function in human immunodeficiency virus-infected South African infants compared with uninfected.

Infant human immunodeficiency virus (HIV) infection remains a problem in different parts of the world. Early signs of disease manifestation often involve infant skin. This study compared the skin barrier properties of HIV infected with uninfected infants. A cross-sectional descriptive study was undertaken with HIV positive and HIV negative unexposed African infants (6 weeks-12 months). Both had normal birth weight for age, no pre-existing dermatoses or co-infections, and received all their vaccinations timeously. The HIV positive infants were on antiretroviral (ARV) therapy. The skin barrier quality was assessed by measuring the transepidermal water loss (TEWL) and skin surface hydration (SSH) on the dorsal arm (1) and the inner forearm (2). Eighty-six HIV negative and 43 HIV positive African children were recruited. There were significant differences between the two groups based on the presence of HIV infection. In both sites, measured TEWL rates were significantly higher for the HIV positive children. There was a nonsignificant difference between the SSH values for site 1 and a marginally significant difference for site 2, with the average values higher in the HIV positive group. In both groups, TEWL rates and SSH values were significantly lower on site 1 compared to site 2. Differences in skin barrier properties of HIV infected and uninfected children may exist. The altered skin barrier in infected children may be one of the factors that predisposes them to various inflammatory and infectious dermatoses. Improving the skin barrier may assist in preventing these conditions.

Hepatocellular carcinoma in Hepatitis B and Human Immunodeficiency Virus coinfection in Africa: a focus on surveillance.

Human immunodeficiency virus (HIV) and hepatitis-B virus (HBV) infections are weighty public health challenges, especially in the African continent. The direct carcinogenic effect of HBV means that it remains a potent cause of early-onset hepatocellular carcinoma (HCC) in Sub-Saharan Africa (SSA), where it causes significant morbidity and mortality. The presence of HIV infection in HBV-infected patients poses a complicating factor, as coinfection has been shown to hasten the progression of liver disease to cirrhosis and HCC, and often resulting in early-age hepatocarcinogenesis with consequent late diagnosis and lower survival. In this review, we discuss this unique conundrum, the epidemiology of HIV-HBV coinfection in SSA, its effect on liver disease and development of HCC, as well as practices and barriers to HCC surveillance in this distinct population. We propose a way forward to curb this considerable health burden focusing on reduction of disease stigma, the need for easy-to-measure biomarkers, and implementation of large prospective studies in this population.

Activity of chaperones in the endometrium in the presence of HIV

The presence of human immunodeficiency virus (HIV) as a cause of acquired immunodeficiency remains a medical and social problem despite the success of antiretroviral therapy. Heat shock proteins (heat-shock proteins - HSP) are a family of proteins produced by cells in response to stressful conditions. The aim of the study was to determine the activity of heat shock proteins in the endometrium in the presence of HIV infection. Research groups were formed with 25 cases in each group: a group with HIV infection, a group with a combination of HIV infection and alcoholism, and a control group. An immunohistochemical study was conducted with monoclonal antibodies to HSP70 and HSP90. During the study, it was established that the presence of HIV infection and its combination with chronic alcoholism leads to the development of pathological processes in the endometrium (or in the endometrium) with signs of microcirculatory channel disturbances, sclerotic changes, and a tendency to endometrial atrophy. At the same time, there is a reliable activation of HSP70 and HSP90, which can be a sign of early non-plastic changes in the endometrium. Heat shock proteins are recognized by the immune system and cause further development of humoral and cellular immunity reactions. The level of heat shock proteins increases in the foci of inflammation, and they are also involved in the pathogenetic mechanisms of almost all diseases.The level of HSP70 expression increased from ([1.18±0.12] in the control group up to ([2.27±0.14] in the group of HIV infection and ([2.71±0.13] in the group of combination of chronic alcoholism and HIV infection. The level of HSP90 expression increased from ([0.73±0.09] in the control group up to ([2.13±0.13] in the group of combination of chronic alcoholism and HIV infection ([2.70±0.13] (p&lt;0.05). Keywords: immune response, transformation, heat-shock proteins.

Heterogeneity of NK-cells in pulmonary tuberculous granulomas, including association with HIV infection

Interest in the study of cell population heterogeneity among immune system grows with advances in multicolor flow cytometry techniques. Natural killer cells are represented by several subpopulations. Their maturation is a continuous process that begins with CD27-CD11b--cells and ends with mature cells with the CD27-CD11b+-phenotype. Phthisiology is one of the areas for studying the NK-cell polymorphism due to the fact that the mechanism of prolonged persistence of M. tuberculosis in the human body is not fully understood. Moreover, there is increasing number of patients with infectious comorbidities, including the human immunodeficiency virus (HIV) infection. The aim of this study was to determine some subpopulations of NK cells in the patients with pulmonary tuberculous granuloma, as well as in the absence of a synergistic HIV infection.The study involved 46 people grouped in three cohorts. The 1st group included 24 practically healthy people, the 2nd group consisted of 12 patients with pulmonary tuberculous granuloma without clinical and laboratory signs of HIV infection, and the 3rd group was represented by 10 patients with pulmonary tuberculous granuloma infected with HIV. The causative agent of pulmonary tuberculosis in all patients was drug-resistant. All the patients with HIV infection had stage 4 disease. Immunological status was assessed by flow cytometry. The following cell populations were detected: CD45+CD3+CD19-, CD45+CD3-CD19+, CD45+CD3-CD16+CD56+, CD3+CD16+CD56+, CD45+CD3-CD8+, CD45+CD3-HLA-DR+, CD45+CD3-CD16+CD56+CD11b+. Leukocytosis and leukogram were determined with a 5 Diff Mythic 22 AL clinical analyzer (Cormay, Poland). Statistical studies of the data were performed in the Windows 10 operating environment (Microsoft Corp., USA); the computer program Statistica v. 12.5 (StatSoft, USA) was used. The normality of the data distribution was also evaluated. Kruskal–Wallis one-way analysis of variance (pk-w) was used as criterion for assessing differences between the compared groups at a significance level of differences p 0.017 (between three unrelated groups), as well as Wald–Wolfowitz test (pw-w) with a significance level of differences p 0.05. Factor analysis was performed.We have found that the presence of pulmonary tuberculous granuloma is accompanied by a decrease of NK-cells number by 33%, a two-fold decrease in the number of NKT-cells, a 34.3% decrease in the population of CD3-HLA-DR+-cells, and a 21.7% decrease in the number of CD3-CD16+CD56+CD11b+-cells. Coinfection with HIV in cases of pulmonary tuberculous granuloma was associated with a three-fold decrease in the leukocyte numbers, significant variability in lymphocyte counts, e.g., 3-fold decrease in NK-cell counts, with NK-cells expressing α-chain of the CD8 antigen decreased by 2.3 times; 6-fold drop of NKT-cell, CD3-HLA-DR+-cells decreased by 42.9%; 2.3-fold decline in CD3-CD16+CD56+CD11b+-cells. Decreased control of M. tuberculosis infection was observed both in patients with pulmonary tuberculous granuloma, and in presence of HIV infection as associated comorbidity.

Prevalence of human papillomavirus (Papillomaviridae; Human papillomavirus) of high carcinogenic risk based on the results of screening of three anatomical loci in men stratified by sexual behavior and HIV status

Human papillomavirus (HPV) of high carcinogenic risk (HCR), in addition to being the etiological agent of cervical cancer, also contribute to development of cancer of the anus, vagina, penis, vulva and oropharyngeal cancer. In this connection, further study of the biological properties of this agent and its prevalence in different populations is an urgent task.The aim of the study was to examine the prevalence of HCR HPV in three anatomical loci in men stratified by HIV (human immunodeficiency virus) infection status (negative, HIV+/positive/HIV-) as well as by sexual behavior: men who have sex with men (MSM), heterosexual men (HM). The study included 256 men from Moscow and Moscow region: 73 МSМ/HIV+, 66 МSМ/ HIV-, 58 HM/HIV+, and 59 HM/HIV-. All men were tested for 14 HCR genotypes of HPV (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68). Smears were taken from three anatomical loci: urethra, anus, oropharynx. Testing was preformed using real-time polymerase chain reaction assay (PCR-RT). The highest prevalence of HCR HPV detection, regardless of the locus, was recorded for МSМ/HIV+ (82.2%), and the lowest for HM/HIV (20.3%). The highest detection of HCR HPV in scrapings of epithelial cells from anus was recorded for МSМ/HIV+ (79.5%). The highest incidence of this pathogen in oropharynx also was registered for МSМ/HIV+ (13.7%). The highest incidence of HCR HPV in scrapings of epithelial cells from urethra was recorded for HM/HIV+ (24%). The prevalence of HCR HPV among men was found to differ markedly depending on the anatomical locus, HIV status and sexual behavior. For the first time, there were obtained data on the prevalence of HCR HPV in men with different patterns of sexual behavior and HIV status in the Moscow region. Screening for HCR HPV in male population based on the identification of 14 genotypes of the virus in three anatomical loci (urethra, oropharynx, anus) by PCR-RT will provide the information necessary to improve the system of epidemiological monitoring and proper planning of preventive measures among men with any risk factors for HPV persistence (presence of HIV infection and/or belonging to the MSM group). HPV screening algorithm development is required for men considering their HIV status and sexual behavior. We recommend testing for 14 HCR HPV genotypes in three loci (urethra, anus, oropharynx).

Correlation of clinical profile toward oral manifestations of HIV/AIDS patients

Introduction: Human Immunodeficiency Virus (HIV) exhibits the capability to weaken human immune system. The infected subject will later be more susceptible to suffer from opportunistic diseases when the CD4 cell count is lesser than 200 cell/µL. Oral Thrush, periodontal disease and xerostomia are common oral manifestations in AIDS patient which initially indicate the presence of HIV infection. No research has been conducted to discuss the association between oral manifestation HIV/AIDS toward socio-demographic and clinical profile of the HIV/AIDS patients. Therefore, this study was aimed to analyse the association between oral manifestation HIV/AIDS toward socio-demographic and clinical profile of the HIV/AIDS patients. Methods: This was an analysis study with cross sectional design performed in 2019. The data of clinical profil of HIV AIDS patient and oral manifestation were obtained from secondary data of medical record.The 55 samples were taken with total sampling technique. Results: Chi-square test showed there was a significant correlation between number of CD4 with candidiasis, oral thrush and periodontal disease. There was a significant correlation between duration of ARV therapy and candidiasis, oral thrush (p&lt;0.05). Conclusion: There is a correlation between the number of CD4 cells and the duration of ARV treatment on candidiasis,oral thrush, periodontal disease and xerostomia.

Diagnosis by molecular pathology of an early and atypical histoplasmosis lesion in the duodenum of an immunocompromised patient: A case report.

Histoplasmosis is a fungal infection caused by Histoplasma capsulatum (HC), which can occasionally be aggressive resulting in the formation of granulomatous lesions. These are usually located in the lungs; however, immunocompromised patients may occasionally develop disseminated lesions in other organs as well. Human immunodeficiency virus (HIV) primarily infects cells of the immune system expressing CD4 molecules. Not only does HIV multiply within these cells, but it can also kill them or otherwise cause loss of cellular function, leading to an immunocompromised state. As a result, in an immunocompromised patient, infection with HC can have serious implications, often the development of visceral histoplasmosis in different organs. Although several types of lesions are formed in HC-infected organs, it may be difficult to distinguish the causative organism from other pathogens based on morphology alone. The present case report describes the case of a 57-year-old woman, from South America, who may have been infected with HC >20 years previously, remaining asymptomatic over the years. She later developed a lesion in the duodenum associated with immunodeficiency caused by HIV infection. The differential diagnosis of this case was made on the basis of several specific morphological findings using histopathological analysis and molecular pathological techniques. The pathogenesis of characteristic lesions caused by HC in the presence of HIV infection was also reviewed.

Genetic architecture of cardiometabolic risks in people living with HIV

BackgroundAdvances in antiretroviral therapies have greatly improved the survival of people living with human immunodeficiency virus (HIV) infection (PLWH); yet, PLWH have a higher risk of cardiovascular disease than those without HIV. While numerous genetic loci have been linked to cardiometabolic risk in the general population, genetic predictors of the excessive risk in PLWH are largely unknown.MethodsWe screened for common and HIV-specific genetic variants associated with variation in lipid levels in 6284 PLWH (3095 European Americans [EA] and 3189 African Americans [AA]), from the Centers for AIDS Research Network of Integrated Clinical Systems cohort. Genetic hits found exclusively in the PLWH cohort were tested for association with other traits. We then assessed the predictive value of a series of polygenic risk scores (PRS) recapitulating the genetic burden for lipid levels, type 2 diabetes (T2D), and myocardial infarction (MI) in EA and AA PLWH.ResultsWe confirmed the impact of previously reported lipid-related susceptibility loci in PLWH. Furthermore, we identified PLWH-specific variants in genes involved in immune cell regulation and previously linked to HIV control, body composition, smoking, and alcohol consumption. Moreover, PLWH at the top of European-based PRS for T2D distribution demonstrated a > 2-fold increased risk of T2D compared to the remaining 95% in EA PLWH but to a much lesser degree in AA. Importantly, while PRS for MI was not predictive of MI risk in AA PLWH, multiethnic PRS significantly improved risk stratification for T2D and MI.ConclusionsOur findings suggest that genetic loci involved in the regulation of the immune system and predisposition to risky behaviors contribute to dyslipidemia in the presence of HIV infection. Moreover, we demonstrate the utility of the European-based and multiethnic PRS for stratification of PLWH at a high risk of cardiometabolic diseases who may benefit from preventive therapies.

HCV adaptation to HIV coinfection

Human immunodeficiency virus (HIV) infection is rising as a leading cause of morbidity and mortality among hepatitis C virus (HCV)-infected patients. Both viruses interact in co-infected hosts, which may affect their intra-host evolution, potentially leading to differing genetic composition of viral populations in co-infected (CIP) and mono-infected (MIP) patients. Here, we investigate genetic differences between intra-host variants of the HCV hypervariable region 1 (HVR1) sampled from CIP and MIP. Nucleotide (nt) sequences of intra-host HCV HVR1 variants (N = 28,622) obtained from CIP (N = 112) and MIP (n = 176) were represented using 148 physical-chemical (PhyChem) indexes of DNA nt dimers. Significant (p < .0001) differences in the means and frequency distributions of 7 PhyChem properties were found between HVR1 variants from both groups. Linear projection analysis of 29 PhyChem features extracted from such PhyChem properties showed that the CIP and MIP HVR1 variants have a distinct distribution in the modeled 2D-space, with only ~1.3% of PhyChem profiles (N = 6782), shared by all HVR1 variants, being found in both groups. Probabilistic neural network (PNN) and naïve Bayesian (NB) classifiers trained on the PhyChem features accurately classified HVR1 variants by the group in cross-validation experiments (AUROC ≥ 0.96). Similarly, both models showed a high accuracy (AUROC ≥ 0.95) when evaluated on a test dataset of HVR1 sequences obtained from 10 patients, data from whom were not used for model building. Both models performed at the expected lower accuracy on randomly labeled datasets in cross-validation experiments (AUROC = 0.50). The random-label trained PNN showed a similar drop in accuracy on the test dataset (AUROC = 0.48), indicating that the detected associations were unlikely due to random correlations. Marked differences in genetic composition of HCV HVR1 variants sampled from CIP and MIP suggest differing intra-host HCV evolution in the presence of HIV infection. PhyChem features identified here may be used for detection of HIV infection from intra-host HCV variants alone in co-infected patients, thus facilitating monitoring for HIV introduction to high-risk populations with high HCV prevalence.

Modeling the Mechanisms by Which HIV-Associated Immunosuppression Influences HPV Persistence at the Oral Mucosa.

Human immunodeficiency virus (HIV)-infected patients are at an increased risk of co-infection with human papilloma virus (HPV), and subsequent malignancies such as oral cancer. To determine the role of HIV-associated immune suppression on HPV persistence and pathogenesis, and to investigate the mechanisms underlying the modulation of HPV infection and oral cancer by HIV, we developed a mathematical model of HIV/HPV co-infection. Our model captures known immunological and molecular features such as impaired HPV-specific effector T helper 1 (Th1) cell responses, and enhanced HPV infection due to HIV. We used the model to determine HPV prognosis in the presence of HIV infection, and identified conditions under which HIV infection alters HPV persistence in the oral mucosa system. The model predicts that conditions leading to HPV persistence during HIV/HPV co-infection are the permissive immune environment created by HIV and molecular interactions between the two viruses. The model also determines when HPV infection continues to persist in the short run in a co-infected patient undergoing antiretroviral therapy. Lastly, the model predicts that, under efficacious antiretroviral treatment, HPV infections will decrease in the long run due to the restoration of CD4+ T cell numbers and protective immune responses.

Renal transplantation in HIV-positive patients - No more a scare!

Human immunodeficiency virus (HIV) infection has posed as a major global health epidemic for almost three decades. With the advent of highly active antiretroviral therapy in 1996 and the application of prophylaxis and management of opportunistic infections, acquired immunodeficiency syndrome mortality has decreased markedly. The most aggressive HIV-related renal disease is end-stage renal disease due to HIV-associated nephropathy. Presence of HIV infection used to be viewed as a contraindication to renal transplantation for multiple reasons; concerns for exacerbation of an already immunocompromised state by administration of additional immunosuppressants; the use of a limited supply of donor organs with unknown long-term outcomes. Multiple studies have reported promising outcomes at three to five years after kidney transplantations in patients treated with highly active antiretroviral therapy, and HIV is no longer a contraindication for renal transplant. Hence, we present eight HIV-positive patients who received live-related renal transplantation at our center and their follow-up.

HIV infection and domestic smoke exposure, but not human papillomavirus, are risk factors for esophageal squamous cell carcinoma in Zambia: a case-control study.

There is emerging evidence that esophageal cancer occurs in younger adults in sub-Saharan Africa than in Europe or North America. The burden of human immunodeficiency virus (HIV) is also high in this region. We postulated that HIV and human papillomavirus (HPV) infections might contribute to esophageal squamous cell carcinoma (OSCC) risk. This was a case–control study based at the University Teaching Hospital in Lusaka, Zambia. Cases were patients with confirmed OSCC and controls had completely normal upper endoscopic evaluations. A total of 222 patients were included to analyze the influence of HIV infection; of these, 100 patients were used to analyze the influence of HPV infection, alcohol, smoking, and exposure to wood smoke. The presence of HIV infection was determined using antibody kits, and HPV infection was detected by polymerase chain reaction. HIV infection on its own conferred increased risk of developing OSCC (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.0–5.1; P = 0.03). The OR was stronger when only people under 60 years were included (OR 4.3; 95% CI 1.5–13.2; P = 0.003). Cooking with charcoal or firewood, and cigarette smoking, both increased the odds of developing OSCC ([OR 3.5; 95% CI 1.4–9.3; P = 0.004] and [OR 9.1; 95% CI 3.0–30.4; P < 0.001], respectively). There was no significant difference in HPV detection or alcohol intake between cases and controls. We conclude that HIV infection and exposure to domestic and cigarette smoke are risk factors for OSCC, and HPV immunization unlikely to reduce OSCC incidence in Zambia.

Cytokine expression in the cervical stroma of HIV-positive and HIV-negative women with cervical intraepithelial neoplasia.

Cervical intraepithelial neoplasias (CINs) are a major public health issue. The prevalence of CINs is higher in women with the human immunodeficiency virus (HIV). The objective of this study was to determine whether there are differences in the immune responses in the cervical stroma of HIV-infected and -uninfected women with CIN. The responses were assessed according to the immunohistochemical expression of cytokines interleukin (IL)-4, IL-12, interferon gamma (IFN-γ), and tumor growth factor beta (TGF-β). In addition, we determined whether there were differences in the local immune responses between patients with CIN1 and CIN 2/3. A cross-sectional study was performed using material collected by cervical conization in HIV-infected and -uninfected women with CIN. The conization was performed using loop electrical excision procedure (LEEP) from January 1999 to May 2004. The evaluation of cytokines in the cervical stroma was based on immunohistochemistry. No differences were found between the two groups of women regarding HIV status. However, the associations between IL-12 expression and CIN 2/3 (p=0.016) in HIV-infected women and between IL-4 expression and CIN 1 (p=0.0456) in HIV-infected women were significant when the interaction between HIV infection and lesion grade was assessed. Additionally, a significant association between TGF-β expression and CIN 2/3 in both groups was observed regardless of HIV infection (p=0.000). An interaction between HIV infection and CIN grade was detected because IL-12 and IL-4 expression increased in the presence of HIV infection. Regarding the CIN grade, there was a high prevalence of TGF-β in CIN 2/3 lesions, which reflected the predominance of an immunoregulatory environment.

Evaluation of various techniques among clinically suspected patients of pulmonary tuberculosis with and without the presence of HIV infection

Tuberculosis (TB) remains a major global health problem in India and globally. The present study was conducted to evaluate the different diagnostic techniques in suspected cases of pulmonary tuberculosis with or without the presence of HIV (Human Immunodeficiency Virus) infection. A total of 75 clinically suspected fresh cases of pulmonary TB were asked for sputum samples for acid-fast bacilli (AFB) staining and culture on Lowenstein-Jensen (LJ) media according to Revised National Tuberculosis Control Program guidelines. A commercially available rapid test kit was also used for detection of TB antigen in sputum sample. One 5 mL blood sample each was taken for HIV testing according to National Aids Control Organisation guidelines. A total of 9 (12%) patients out of 75, were found to be HIV-positive. Among the HIV co-infected patients, there was only one patient who was both smear and culture positive rest were negative. On the other hand, among the 66 HIV-negative TB patients, 25 (37.88%) were positive on both smear and culture. None of the smear negative and culture negative samples was found to be positive for the presence of TB antigen. The overall antigen positivity rate in the entire study was 16% (12/75). The current study concluded that LJ media is highly efficient medium for recovery and diagnosis of Mycobacterium tuberculosis.

PREVALENCE OF HERPES SIMPLEX VIRUS TYPE 2 AND RISK FACTORS ASSOCIATED WITH THIS INFECTION IN WOMEN IN SOUTHERN BRAZIL

SUMMARYThe herpes simplex virus type 2 (HVS-2) is the most prevalent infection worldwide. It is a cofactor in the acquisition of human immunodeficiency virus (HIV) and the persistence of human papillomavirus (HPV). This study evaluated the prevalence of HSV-2, using the polymerase chain reaction (PCR), and associated factors in patients treated at the Federal University of Rio Grande (FURG) and Basic Health Units (BHU) in Rio Grande, Brazil. The observed prevalence of HSV-2 was 15.6%. Among the 302 women studied, 158 had received assistance in BHU and 144 were treated at FURG. The prevalence of HSV-2 in these groups was 10.8% and 20.8%, respectively, RR 1.9 and p = 0.012. Knowledge about the Pap smear, and the presence of lesions showed no association with HSV-2 infection. Multivariate analysis showed that the variable that most influenced the risk of HSV-2 infection was the presence of HIV infection, with a relative risk of 1.9 and p = 0.04. Discussion: Genital ulcers are an important entry point for HIV, and condom use is an important strategy to reduce transmission of HIV and HSV-2.

First and Second Trimester Markers of Fetal Aneuploidy in Pregnant Women with HIV Infection

Objective: To evaluate if levels of pregnancy-associated plasma protein-A (PAPP-A), free β-hCG and nuchal translucency (NT) used in first trimester aneuploidy screening and α-fetoprotein (AFP), unconjugated oestriol (UE3) and free β-hCG in the second trimester are altered in pregnancies with human immunodeficiency virus (HIV) infection. Methods: Median MoM values of biochemical markers and δ-NT in 92 women with HIV infection in the first trimester were compared with those from 912 HIV-seronegative controls. In the second trimester, biochemical marker levels were compared in 52 women with HIV infection and 378 HIV-seronegative controls. Results: First trimester free β-hCG median MoM levels in HIV-infected pregnancies were not different to controls (0.978 vs. 0.981, p = 1.000), as were PAPP-A levels (1.190 vs. 1.102, p = 0.099) and δ-NT (0.1374 vs. 0.0445, p = 0.0631). Second trimester levels of free β-hCG were not significantly different (1.0575 vs. 0.9619, p = 0.1827), as was AFP (0.9734 vs. 0.9350, p = 0.6576), although UE3 was significantly lower (0.970 vs. 1.110, p = 0.0005). Conclusions: In the first trimester, marker levels are not affected by the presence of HIV infection, and risks for aneuploidy are likely to be accurate in this group. Further studies are required to evaluate if UE3 levels continue to be low in HIV-infected women since this may have an impact on screening in the second trimester.

Prevalence and risk factors for cervical intraepithelial neoplasia in HIV-infected women in Salvador, Bahia, Brazil.

The human immunodeficiency virus (HIV) is frequently associated with high-grade intraepithelial neoplasia. Immunosuppression and high HIV viral load are the main risk factors for cervical intraepithelial neoplasia (CIN). The aim of this study was to determine the prevalence of CIN in HIV-infected women in Salvador, Bahia, Brazil, and to describe the risk factors in comparison with non-infected women. Cross-sectional study at the AIDS Reference Center of Bahia and the Gynecological Outpatient Clinic of Fundação Bahiana para o Desenvolvimento da Ciência, in Salvador, Bahia, Brazil. Sixty-four HIV-infected women and 76 uninfected women from Salvador were enrolled between May 2006 and May 2007. Associations between CIN and presence of HIV infection, HIV viral load, proportion of T CD4+ lymphocytes and risk factors were evaluated. The independence of the risk factors was investigated using logistic regression. CIN was more prevalent among HIV-infected women than in the control group (26.6% versus 6.6%; P = 0.01). The odds ratio for CIN among HIV-infected women was 3.7 (95% confidence interval, CI: 1.23-11; P = 0.01), after adjusting for the following variables: age at first sexual intercourse, number of partners, number of deliveries and previous history of sexually transmitted disease. The prevalence of CIN among HIV-infected women was significantly higher than among women without HIV infection. HIV infection was the most important risk factor associated with the development of cervical lesions.