Human Immunodeficiency Virus Disease Progression Research Articles

Synergistic Impairment of the Neurovascular Unit by HIV-1 Infection and Methamphetamine Use: Implications for HIV-1-Associated Neurocognitive Disorders

The neurovascular units (NVU) are the minimal functional units of the blood–brain barrier (BBB), composed of endothelial cells, pericytes, astrocytes, microglia, neurons, and the basement membrane. The BBB serves as an important interface for immune communication between the brain and peripheral circulation. Disruption of the NVU by the human immunodeficiency virus-1 (HIV-1) induces dysfunction of the BBB and triggers inflammatory responses, which can lead to the development of neurocognitive impairments collectively known as HIV-1-associated neurocognitive disorders (HAND). Methamphetamine (METH) use disorder is a frequent comorbidity among individuals infected with HIV-1. METH use may be associated not only with rapid HIV-1 disease progression but also with accelerated onset and increased severity of HAND. However, the molecular mechanisms of METH-induced neuronal injury and cognitive impairment in the context of HIV-1 infection are poorly understood. In this review, we summarize recent progress in the signaling pathways mediating synergistic impairment of the BBB and neuronal injury induced by METH and HIV-1, potentially accelerating the onset or severity of HAND in HIV-1-positive METH abusers. We also discuss potential therapies to limit neuroinflammation and NVU damage in HIV-1-infected METH abusers.

T-Cell Immune Dysregulation and Mortality in Women With Human Immunodeficiency Virus.

In women with HIV, higher activation and exhaustion of CD4+ T cells were associated with risk of non-HIV-related mortality during a median of 13.3 years of follow-up, independent of baseline demographic, behavioral, HIV-related, and cardiometabolic factors and longitudinal HIV disease progression. Dysregulation of adaptive immunity is a hallmark of human immunodeficiency virus (HIV) infection that persists on antiretroviral therapy (ART). Few long-term prospective studies have related adaptive immunity impairments to mortality in HIV, particularly in women. Among 606 women with HIV in the Women's Interagency HIV Study, peripheral blood mononuclear cells collected from 2002 to 2005 underwent multiparameter flow cytometry. Underlying cause of death was ascertained from the National Death Index up to 2018. We examined associations of CD4+ and CD8+ T-cell activation (%CD38+HLA-DR+), senescence (%CD57+CD28-), exhaustion (%PD-1+), and nonactivation/normal function (%CD57-CD28+) with natural-cause, HIV-related, and non-HIV-related mortality. At baseline, median participant age was 41, and 67% were on ART. Among 100 deaths during a median of 13.3 years follow-up, 90 were natural-cause (53 non-HIV-related, 37 HIV-related). Higher activation and exhaustion of CD4+ T cells were associated with risk of natural-cause and non-HIV-related mortality, adjusting for age, demographic, behavioral, HIV-related, and cardiometabolic factors at baseline. Additional adjustment for time-varying viral load and CD4+ T-cell count did not attenuate these associations. CD8+ T-cell markers were not associated with any outcomes adjusting for baseline factors. Persistent CD4+ T-cell activation and exhaustion may contribute to excess long-term mortality risk in women with HIV, independent of HIV disease progression.

Seroprevalence of Human Herpesvirus Infections in Newly Diagnosed HIV-Infected Key Populations in Dar es Salaam, Tanzania.

Background Human herpesvirus (HHV) infections can significantly increase the risk of human immunodeficiency virus (HIV) transmission and accelerate disease progression. In the population at high risk of HIV infection, also termed as key populations (female sex workers (FSW), men who have sex with men (MSM), and people who inject drugs (PWID)), and their sexual partners, HHV infections can potentially compromise the efforts to prevent and control HIV infection. Here, we investigated the seroprevalence of HHV infections among HIV-infected key populations in Dar es Salaam, Tanzania. Methodology. We analyzed 262 archived serum samples of HIV-infected key populations from the integrated biobehavioral surveillance (IBBS) study conducted in Dar es Salaam, Tanzania. The enzyme-linked immunosorbent assay was used to determine IgG and IgM titers for cytomegalovirus (CMV) and herpes simplex virus (HSV) types 1 and 2. Results The overall seropositivity of HHV IgG was 92% (95% CI: 87.7–95.3%). HHV IgM was not detected in any of the samples. The most seroprevalent coinfection was CMV at 69.1% (181/262), followed by HSV-2 33.2% (87/262) and HSV-1 32.1% (84/262). HSV-2 infection differed by key population groups; it accounted for FSW (46.3%) (p=0.0001) compared to PWID (21.6%) and MSM (22.7%). In contrast, seroprevalence for CMV and HSV-1 was comparable across the key population groups; whereby, CMV was 62%, 75.3%, and 75% and HSV-1 was 26.4%, 39.2%, and 31.8% for FSW, MSM, and PWID, respectively. We also observed that multiple coinfections with CMV-HSV-2 (p=0.042) and CMV-HSV-1-HSV-2 (p=0.006) were significantly associated with key population aged above 40 years. Conclusion The IgG seroprevalence of CMV, HSV-1, and HSV-2 was high among HIV-positive key populations. These findings indicate that these individuals are prone to recurrence of HHV infections and may harbor replicating viruses that subsequently may affect HIV disease progression. Therefore, this warrants concerted efforts for integrated HIV and sexually transmitted infection prevention programs targeting key populations.

A Tale of Two Viruses: Immunological Insights Into HCV/HIV Coinfection.

Nearly 2.3 million individuals worldwide are coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). Odds of HCV infection are six times higher in people living with HIV (PLWH) compared to their HIV-negative counterparts, with the highest prevalence among people who inject drugs (PWID) and men who have sex with men (MSM). HIV coinfection has a detrimental impact on the natural history of HCV, including higher rates of HCV persistence following acute infection, higher viral loads, and accelerated progression of liver fibrosis and development of end-stage liver disease compared to HCV monoinfection. Similarly, it has been reported that HCV coinfection impacts HIV disease progression in PLWH receiving anti-retroviral therapies (ART) where HCV coinfection negatively affects the homeostasis of CD4+ T cell counts and facilitates HIV replication and viral reservoir persistence. While ART does not cure HIV, direct acting antivirals (DAA) can now achieve HCV cure in nearly 95% of coinfected individuals. However, little is known about how HCV cure and the subsequent resolution of liver inflammation influence systemic immune activation, immune reconstitution and the latent HIV reservoir. In this review, we will summarize the current knowledge regarding the pathogenesis of HIV/HCV coinfection, the effects of HCV coinfection on HIV disease progression in the context of ART, the impact of HIV on HCV-associated liver morbidity, and the consequences of DAA-mediated HCV cure on immune reconstitution and HIV reservoir persistence in coinfected patients.

Levels of Total Antioxidant Capacity, sCD14, and TGF-β2 in Breast Milk Plasma of HIV-Infected and HIV-Uninfected Lactating Women.

Introduction: Breast milk provides nourishment for infants and nonnutritive bioactive factors, which possess key protective and developmental benefits essential in shaping the infant immune system. However, the impact of human immunodeficiency virus (HIV) and universal antiretroviral therapy (ART) on breast milk nutritional composition and immunity status is not well documented. Objective: The study aimed to compare breast milk immune factors; total antioxidant capacity (TAC), soluble cluster of differentiation 14 (sCD14), and transcription growth factor-beta 2 (TGF-β2) levels between HIV-infected and HIV-uninfected lactating mothers and determine the association between breast milk parameters with HIV disease progression and duration of ART. Methods: Breast milk sCD14, TAC, and TGF-β2 were quantified using enzyme-linked immunosorbent assays and spectrophotometric techniques in 57 HIV-infected breast feeding mothers on option B+ therapy for prevention of vertical transmission of HIV and 57 HIV-uninfected mothers at 6 weeks postpartum. The plasma HIV viral load was measured on enrollment and demographic data were recorded. Results: Mean breast milk plasma TAC levels were significantly lower in HIV-infected mothers (1,250.5 ± 280.4 μmolTE/L) compared to the HIV-uninfected participants (1,915.4 ± 326 μmolTE/L; p < 0.001). Soluble CD14 levels in HIV-infected mothers were significantly higher (7,059.3 ± 1,604.7 ng/mL) compared to the HIV-uninfected group (5,670.7 ± 1,268.3 pg/mL; p < 0.001). Similarly, TGF-β2 concentration was also significantly elevated in the HIV-infected mothers (1,426.1 ± 695.4 pg/mL) compared to the HIV-uninfected counterparts (709.2 ± 196.8 pg/mL; p < 0.001). A positive correlation was observed between breast milk plasma sCD14 concentration and the plasma viral load (r = 0.576, p < 0.001), while a significant negative correlation was observed with the duration of ART (r = -0.285, p = 0.032). TAC and TGF-β2 concentrations were inversely correlated with plasma viral load levels. Conclusion: HIV-infected mothers are at risk of oxidative stress. Nutritional intervention with antioxidant rich foods is recommended for this vulnerable group during breastfeeding.

Disease Progression in Children With Perinatal Human Immunodeficiency Virus Correlates With Increased PD-1+ CD8 T Cells That Coexpress Multiple Immune Checkpoints.

PD-1 marks exhausted T cells, with weak effector functions. Adults living with human immunodeficiency virus (HIV) have increased levels of PD-1+ CD8 T cells that correlate with HIV disease progression, yet little is known about the role of PD-1+ CD8 T cells in children with perinatal HIV. We enrolled 76 Kenyan children with perinatal HIV and 43 children who were HIV unexposed and quantified PD-1 levels on CD8 T cells; their coexpression with immune checkpoints (ICs) 2B4, CD160, and TIM3; correlates with immune activation and HIV disease progression; and HIV-specific and -nonspecific proliferative responses. PD-1+ CD8 T-cell frequencies are elevated in children with perinatal HIV and associated with disease progression. The majority of PD-1+ CD8 T cells coexpress additional ICs. ART initiation lowers total PD-1 levels and coexpression of multiple ICs. The frequency of PD-1+2B4+CD160+TIM3- in PD-1+ CD8 T cells predicts weaker HIV-specific proliferative responses, suggesting that this subset is functionally exhausted. Children with perinatal HIV have high levels of PD-1+ CD8 T cells that are a heterogeneous population differentially coexpressing multiple ICs. Understanding the complex interplay of ICs is essential to guide the development of PD-1-directed immunotherapies for pediatric HIV remission and cure.

Computer-based alcohol reduction intervention for alcohol-using HIV/HCV co-infected Russian women in clinical care: study protocol for a randomized controlled trial

BackgroundRussia has a high prevalence of human immunodeficiency virus (HIV) infections. In 2018, over one million persons were living with HIV (PLWH); over a third were women. A high proportion of HIV-infected women are co-infected with hepatitis C virus (HCV), and many consume alcohol, which adversely affects HIV and HCV treatment and prognosis. Despite the triple epidemics of alcohol use, HIV and HCV, and the need for interventions to reduce alcohol use among HIV/HCV co-infected women, evidence-based alcohol reduction interventions for this vulnerable population are limited. To address this gap, we developed a clinical trial to evaluate the efficacy of a computer-based intervention to reduce alcohol consumption among HIV/HCV co-infected women in clinical care.MethodsIn this two-arm parallel randomized controlled trial, we propose to evaluate the efficacy of a culturally adapted alcohol reduction intervention delivered via a computer for HIV/HCV co-infected Russian women. The study population consists of women 21–45 years old with confirmed HIV/HCV co-infection who currently use alcohol. Intervention efficacy is assessed by a novel alcohol biomarker, ethyl glucuronide (EtG), and biomarkers of HIV and HCV disease progression. Women are randomized to trial conditions in a 1:1 allocation ratio, using a computer-generated algorithm to develop the assignment sequence and concealment of allocation techniques to minimize assignment bias. Women are randomized to either (1) the computer-based alcohol reduction intervention or (2) the standard-of-care control condition. We will use an intent-to-treat analysis and logistic and linear generalized estimating equations to evaluate intervention efficacy, relative to the standard of care, in enhancing the proportion of women with a laboratory-confirmed negative EtG at each research study visit over the 9-month follow-up period. Additional analyses will evaluate intervention effects on HIV (viral load and CD4+ levels) and HCV markers of disease progression (FibroScan).DiscussionThe proposed trial design and analysis provides an appropriate conceptual and methodological framework to assess the efficacy of the computer-based intervention. We propose to recruit 200 participants.The intervention, if efficacious, may be an efficient and cost-effective alcohol reduction strategy that is scalable and can be readily disseminated and integrated into clinical care in Russia to reduce women’s alcohol consumption and enhance HIV/HCV prognosis.Trial registrationClinicalTrials.gov NCT03362476. Registered on 5 December 2017

Depression and suicidal ideation among HIV seropositive patients attending the special treatment clinic of the University of Calabar Teaching Hospital, Calabar, Nigeria

Objectives: The introduction of highly active antiretroviral therapy and innovations in healthcare has contributed in improving the lives of persons living with human immunodeficiency virus (HIV)/AID. Patients infected with HIV are more susceptible to develop psychiatric illnesses. Depression is common among patients suffering from chronic illness such as HIV/AIDS and can exacerbate these illnesses. Depression has been observed to be twice as common in HIV seropositive individuals than in the general population. Undiagnosed and untreated depression in patients suffering from HIV/AIDS could lead to poor adherence to medications and lower quality of life. Depression is associated with rapid HIV disease progression. The diagnosis of HIV infection may be associated with feelings of anger, denial, sadness, guilt feelings, loss of self-esteem among others. These negative feelings could lead to suicidal ideation and attempted suicide or suicide. We sought to determine the prevalence rates, sociodemographics and predictors, of depression and suicidal ideation among study participants. Material and methods: Two hundred and two adult participants who met the inclusion criteria were recruited into the study. Mini International Neuropsychiatric Interview English version 6.0.0 was employed to diagnose depression and suicidal ideation. Data were analyzed using Statistical Package for the Social Sciences version 20.0. Significant levels were set at P &lt; 0.05. Results: This study revealed prevalence rates of 11.4% for depression and 7.9% for suicidal ideation among study participants. Majority of the participants were females in the young age group category of 30–40 years (45%) with mostly secondary education (47.8%), most had a higher CD4 count greater than 200 cells/µL (82.6%) and were mainly on zidovudine/lamivudine/nevirapine combination therapy (56.5%). Mean age, CD4 count, and viral load levels were lower in HIV patients with depression but were not statistically significant (P &gt; 0.05). CD4 count and viral load were not significantly associated with suicidal ideation. Lower age (30–40 years) was significantly associated with suicidal ideation (P &lt; 0.05). Suicidal ideation is a predictor of depression in the same way depression is a predictor of suicidal ideation (P &lt; 0.05). Conclusion: Routine screening for depression and suicidal ideation especially among younger HIV/AIDS patients is recommended in the clinic setting.

Association of oral candidal species with human immunodeficiency virus patients of West Godavari district, Andhra Pradesh - An in vitro study.

Introduction:Human immunodeficiency virus (HIV) infection is a major worldwide health problem characterized by progressive immunosuppression. The morbidity of HIV patients is due to its association with opportunistic infections among which oral candidiasis is common. Regardless of HIV status, candidiasis can prevail when their immune system is depressed. Oral candidiasis can thus serve as a useful marker for both restoration of immune functions and HIV disease progression. Routine identification of Candida species is laborious and time-consuming. HICHROM agar stains different species into different colors facilitating rapid reliable identification of candida species as they differ in their virulence and sensitivity to antifungal drugs.Materials and Methods:This cross-sectional study includes a total of 200 HIV seropositive patients from Anti-Retroviral Therapy Centre, West Godavari District. Unstimulated saliva samples were collected in a screw-capped universal container. Five microliters of each sample using a sterile inoculating loop is streaked on the chromogenic agar culture media. The colonies formed are counted using a magnifying glass and LAPIZ colony counter. Candidal colony-forming units per milliliter were analyzed, compared and correlated among different study groups. Different candida species were also identified in the study.Results:Nonalbicans Candida was the most common species isolated in our study accounting for 53% and Candida albicans accounting for 47%. Considering initial and final CD4 counts, there is improvement in patients on retroviral therapy.Conclusion:Identification of the species is important for epidemiological reasons and for treatment purposes to ensure a better prognosis since some species present reduced susceptibility to azoles.

Adapting a Behavioral Intervention for Alcohol Use and HIV Medication Adherence for Lay Counselor Delivery in Cape Town, South Africa: A Case Series

Human immunodeficiency virus (HIV) and problematic alcohol use are two ongoing and interconnected epidemics in South Africa, with untreated problematic alcohol use associated with poorer HIV treatment outcomes and disease progression. A lack of trained mental health providers is a primary barrier to increasing access to evidence-based treatment in this setting. To address this gap, we integrated evidence-based intervention components for problematic alcohol use and antiretroviral therapy (ART) adherence, adapted for lay provider delivery in an HIV primary care setting in Cape Town, South Africa. The intervention, locally termed “Khanya” in isiXhosa, which means glow, direction, or light, comprises Life Steps adherence counseling, motivational interviewing, behavioral activation, and relapse prevention, including mindfulness-based relapse prevention components. In this case series, we present a detailed description of the intervention and provide three clinical cases of individuals who received the Khanya intervention to showcase necessary clinical adaptations and the supervision needed for optimal treatment delivery, flexibility in intervention delivery, and overall successes and challenges. We present descriptive data on alcohol use and ART adherence outcomes for the cases to supplement the narrative discussion. Successes of intervention delivery included participant uptake of mindfulness skills, reductions in alcohol use despite varying levels of motivation, and interventionist mastery over various clinical skills. Challenges included delivering the intervention within the allotted time and the strong influence of substance-using social networks. Overall, a pragmatic approach to intervention delivery was necessary, as was ongoing support for the interventionist to promote fidelity to both treatment components and therapeutic skills.Trial registration: ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018.

Effect of Vitamin D, Selenium, or Zinc Supplementation in HIV: A Systematic Review

We conducted a systematic review to examine evidence from randomized controlled trials studying the effect of Vitamin D, selenium, or zinc supplementation in human immunodeficiency virus (HIV). An electronic literature search was carried out using Ovid Medline, Embase, CINHAL, Cochrane Center Register of Controlled Trials, Database of Systematic Reviews, Psych Info and PubMed. Eligible articles were assessed for methodological quality on the basis of the adequacy of the randomization process, concealment of allocation, blinding of intervention and outcome, and completeness of follow-up. A total of 24 single supplement trials (Vitamin D, selenium, and zinc) involving 5948 participants were included for this review. Evidence from seven Vitamin D trials showed no damaging or beneficial effect of Vitamin D supplementation on HIV disease progression in HIV-infected adults or children/adolescents. Six of the selenium studies found that providing daily selenium supplementation to HIV-infected adults' increased CD4 cell counts and reduce the risk of diarrhea morbidity and hospital admission rate for HIV-related conditions and opportunistic infection in HIV-infected adults. Evidence from eleven zinc trials showed some evidence of a potential beneficial effect of zinc supplementation on diarrhea morbidity and immune function. However, further research in larger and more diverse populations of HIV patients is required to fully investigate the effect of these nutrients on clinically relevant outcomes in HIV disease, the optimal dose, and the cost-benefit or cost-effectiveness of Vitamin D, selenium, or zinc supplementation.

Analysis of blood parameters in HIV positive patients

Human immunodeficiency virus (HIV), the causative agent in AIDS has been a challenge to medical fraternity from the time since it was first discovered in 1983. About 40 million people are living with HIV infection globally and 99% of the infected people are in South East Asia (ESA). Close monitoring of HIV infected patients is essential in reducing the morbidity and mortality of HIV patients. The monitoring HIV disease progression &amp; deciding the time to initiate anti retro viral therapy requires evaluation of T CD4 cell counts and HIV/RNA viral load at regular intervals along with monitoring of biochemical parameters and hematological parameters in HIV Seropositive patients.The objective of the study was to evaluate some biochemical parameters and hematological parameters in newly diagnosed HIV seropositive patients (primary stage).A total of 300 newly diagnosed HIV patients and 200 age and sex matched healthy individuals as control were tested for CBC, lipid profile, renal function tests, liver function tests, electrolytes and some minerals (copper, zinc, iron). Our observations were subjected to statistical analysis Mean ± standard deviation calculated. Comparison was done by student t-test.HIV positive patients had significantly (p&amp;#60;0.001) decreased mean Hb (10.22 ± 1.51) and RBC count (3.99 ± 0.75) compared with HIV negative subjects with Hb (12.52 ± 1.21), RBC count (5.08 ± 0.42). We observed a decrease in total cholesterol, HDL cholesterol and LDL cholesterol, and an increase in triglyceride and VLDL levels. HIV patients increasingly require careful monitoring and evaluation for altered renal function, to prevent co morbidities of treatment and non-treatment related nephrotoxicity. In this study patients with HIV showed significant increase in the mean serum copper level when compared with the control subjects respectively, zinc and iron levels significantly decreased compared with normal subjects.It was concluded in the present study that, hematological manifestations of the HIV infection are complication associated with the disease, anaemia being a very common finding. This complications are not related to age or the sex of the patients. The lipid profile of the patients is also seen to be altered by the disease process. Decreased Lipid levels are more pronounced in anemic groups than non-anemic group.

Impact of sickle cell disease on presentation and progression of paediatric HIV: a retrospective cohort study.

HIV and sickle cell disease (SCD) are significant causes of morbidity and mortality in sub-Saharan Africa. Given their separate roles in immune dysregulation, our objective was to characterise the impact that SCD has on the presentation and progression of paediatric HIV. The study was a retrospective cohort study (study period 2004-2018). Cases of HIV+and SCD-afflicted patients (HIV+/SCD+) were obtained via electronic chart review from a paediatric HIV clinic in Kampala, Uganda and matched 1:3 with HIV+controls without SCD (HIV+/SCD-). Thirty-five HIV+/SCD+subjects and 95 HIV+/SCD- controls were analysed (39% female (51/130), age 3.6years (SD3.9)). At baseline, WHO clinical stage (64% total cohort Stage III/IV) and nutritional status (9.4% severe acute malnutrition) were similar for both groups, whereas HIV+/SCD+had higher though non-significant baseline CD4 count (1036 (SD713) vs 849 (SD638) cells/microlitre, P=0.20, two-tailed t-test). There were 19 deaths, 6 (17%) HIV+/SCD+and 13 (14%) HIV+/SCD-, with unadjusted/adjusted models showing no significant difference. Nutritional progression and clinical stage progression showed no significant differences between groups. Kaplan-Meier analysis showed a slower rate of treatment failures in the HIV+/SCD+cohort (P=0.11, log-rank survival test). Trajectory analysis showed that in the time period analysed, the HIV+/SCD+cohort showed a more rapid rise and higher total CD4 count (P=0.012, regression analysis). The study suggests that SCD does not adversely affect the progression of HIV in patients on ART. Further, HIV+/SCD+achieved higher CD4 counts and fewer HIV treatment failures, suggesting physiological effects due to SCD might mitigate HIV progression.

Polyfunctional HIV-1 specific response by CD8+ T lymphocytes expressing high levels of CD300a

CD300a receptor is found on different CD8+ T cell subsets and its expression has been associated to a more cytotoxic molecular signature. CD300a has an important role in some viral infections and its expression levels are known to be modulated by human immunodeficiency virus (HIV)−1 infection on several cell types. The main objective of this work was to investigate CD300a expression and its regulation during HIV-1 specific CD8+ T cell responses. CD300a receptor expression was analysed by multiparametric flow cytometry on CD8+ T lymphocytes from HIV negative donors, naive HIV-1+ individuals and HIV-1+ subjects under suppressive combined antiretroviral therapy (cART). HIV-1 specific CD8+ T cell response was studied by stimulating cells with HIV-1 derived peptides or with a Gag HIV-1 peptide. Our results showed that HIV-1 specific CD8+ T cells expressing higher levels of CD300a were more polyfunctional showing an increased degranulation and cytokine production. Moreover, we observed an up-regulation of CD300a expression after Gag HIV-1 peptide stimulation. Finally, our results demonstrated an inverse correlation between CD300a expression on CD8+ T lymphocytes and HIV disease progression markers. In conclusion, CD300a expression is associated to a better and more polyfunctional HIV-1 specific CD8+ T cell response.

Modelling immune deterioration, immune recovery and state-specific duration of HIV-infected women with viral load adjustment: using parametric multistate model

BackgroundCD4 cell and viral load count are highly correlated surrogate markers of human immunodeficiency virus (HIV) disease progression. In modelling the progression of HIV, previous studies mostly dealt with either CD4 cell counts or viral load alone. In this work, both biomarkers are in included one model, in order to study possible factors that affect the intensities of immune deterioration, immune recovery and state-specific duration of HIV-infected women.MethodsThe data is from an ongoing prospective cohort study conducted among antiretroviral treatment (ART) naïve HIV-infected women in the province of KwaZulu-Natal, South Africa. Participants were enrolled in the acute HIV infection phase, then followed-up during chronic infection up to ART initiation. Full-parametric and semi-parametric Markov models were applied. Furthermore, the effect of the inclusion and exclusion viral load in the model was assessed.ResultsInclusion of a viral load component improves the efficiency of the model. The analysis results showed that patients who reported a stable sexual partner, having a higher educational level, higher physical health score and having a high mononuclear component score are more likely to spend more time in a good HIV state (particularly normal disease state). Patients with TB co-infection, with anemia, having a high liver abnormality score and patients who reported many sexual partners, had a significant increase in the intensities of immunological deterioration transitions. On the other hand, having high weight, higher education level, higher quality of life score, having high RBC parameters, high granulocyte component scores and high mononuclear component scores, significantly increased the intensities of immunological recovery transitions.ConclusionInclusion of both CD4 cell count based disease progression states and viral load, in the time-homogeneous Markov model, assisted in modeling the complete disease progression of HIV/AIDS. Higher quality of life (QoL) domain scores, good clinical characteristics, stable sexual partner and higher educational level were found to be predictive factors for transition and length of stay in sequential adversity of HIV/AIDS.

Syphilis infection does not affect immunodeficiency progression in HIV-infected men who have sex with men in China.

Syphilis and human immunodeficiency virus (HIV) co-infection is expected to play a role in HIV-1-related immunodeficiency progression; however, studies involving syphilis/HIV co-infection have not been conclusive. We investigated the factors associated with co-infection of syphilis and HIV and to assess the effect of syphilis on HIV progression in the context of HIV-1 diversity in an observational cohort of 246 newly-diagnosed HIV-infected but antiretroviral therapy-naive men who have sex with men enrolled in Guangzhou, China between 2008 and 2012. CD4+ cell counts of all the participants were measured from the time of diagnosis until 2015 with an average of 32 ± 18 months. Logistic analysis indicated that patients with syphilis/HIV co-infection were more likely to be older with an adjusted odds ratio (AOR) of 2.48 (95% CI: 1.28–4.80) for those aged between 31 and 40 years and 3.20 (1.11–9.22) for those aged ≥40 years as compared to 16–30 year-olds. The AOR of patients infected with HIV-1 CRF07_BC as compared to CRF01_AE was 2.14 (95% CI: 1.01–4.53). Co-infection of syphilis and HIV was associated with lower baseline CD4+ cell count (0.45, 95% CI: 0.22–0.94), but was not associated with HIV disease progression (HR: 1.03; 95% CI, 0.86–1.23) based on Kaplan–Meier analysis. Our results provide new evidence about the interaction between syphilis and HIV and indicate differential rates of immunodeficiency progression as a function of HIV-1 genetic diversity.

Trends and Adaptive Optimal Set Points of CD4+ Count Clinical Covariates at Each Phase of the HIV Disease Progression.

In response to invasion by the human immunodeficiency virus (HIV), the self-regulatory immune system attempts to restore the CD4+ count fluctuations. Consequently, many clinical covariates are bound to adapt too, but little is known about their corresponding new optimal set points. It has been reported that there exist few strongest clinical covariates of the CD4+ count. The objective of this study is to harness them for a streamlined application of multidimensional viewing lens (statistical models) to zoom into the behavioural patterns of the adaptive optimal set points. We further postulated that the optimal set points of some of the strongest covariates are possibly controlled by dietary conditions or otherwise to enhance the CD4+ count. This study investigated post-HIV infection (acute to therapy phases) records of 237 patients involving repeated measurements of 17 CD4+ count clinical covariates that were found to be the strongest. The overall trends showed either downwards, upwards, or irregular behaviour. Phase-specific trends were mostly different and unimaginable, with LDH and red blood cells producing the most complex CD4+ count behaviour. The approximate optimal set points for dietary-related covariates were total protein 60–100 g/L (acute phase), <85 g/L (early phase), <75 g/L (established phase), and >85 g/L (ART phase), whilst albumin approx. 30–50 g/L (acute), >45 g/L (early and established), and <37 g/L (ART). Sodium was desirable at approx. <45 mEq/L (acute and early), <132 mEq/L (established), and >134 mEq/L (ART). Overall, desirable approximates were albumin >42 g/L, total protein <75 g/L, and sodium <137 mEq/L. We conclude that the optimal set points of the strongest CD4+ count clinical covariates tended to drift and adapt to either new ranges or overlapped with the known reference ranges to positively influence the CD4+ cell counts. Recommendation for phase-specific CD4+ cell count influence in adaptation to HIV invasion includes monitoring of the strongest covariates related to dietary conditions (sodium, albumin, and total protein), tissue oxygenation (red blood cells and its haematocrit), and hormonal control (LDH and ALP).

Coinfection of Human Immunodeficiency Virus-Infected Patients with Hepatitis B Virus in Lokoja, North Central Nigeria.

Globally, coinfection of human immunodeficiency virus (HIV) patients with Hepatitis B Virus (HBV) is associated with an accelerated progression of HIV disease and higher mortality resulting from complications of liver-related disease. Despite the public health importance, data are lacking on this subject in the study area. Therefore, we evaluated the prevalence and risk factors for HIV/HBV coinfection among HIV patients accessing antiretroviral treatment in Lokoja, Nigeria. In a cross-sectional study, sera from randomly selected 200 consenting HIV patients were screened for hepatitis B surface antigen (HBsAg) using The Commercial Rapid Immunoassay Test Kit. Demographic variables and putative risk factors of HBV transmission were obtained using structured questionnaire. HBsAg prevalence was 8.0% in the sampled group with higher seropositivity rate in the age group, 40-49 years, followed by those 20-29 years of age, whereas the other age groups had zero positivity rates each. The difference between seroprevalence rates in relation to patients' age and sex was not statistically significant (p > 0.05). Patients with no formal education, who were married and were housewives, had higher rates of HBV infection compared with others in the group. Although not statistically significant (p > 0.05), the likelihood of exposure to HBV was higher among patients who were engaged in multiple sexual behaviors, alcoholism, smoking, sharing of sharps, ear piercing, and had history of blood transfusion. Conclusively, HIV/HBV coinfection rate in our study is comparable to other localities and thus, affirm the endemicity in the study area. The need to strengthen health education of the masses to desist from risky behaviors is recommended to reduce the morbidity and mortality arising from HIV/HBV comorbidity.

Beneficial Efficacy of Histone Deacetylase Inhibitor Butyrate and Histone Crotonylation to Human Immunodeficiency Virus-Infected Subjects

The mechanism of how gut microbiota is involved in the host inflammatory processes that influence human immunodeficiency virus (HIV) replication and disease progression in HIV is elucidated in present review.

Impact of micronutrients on the psychological well-being of highly active antiretroviral therapy-naïve human immunodeficiency virus-infected patients

Background: In human immunodeficiency virus (HIV)-infected persons, low serum concentrations of vitamins and minerals, termed micronutrients, may be associated with an increased risk of psychiatric morbidity and HIV disease progression. Objectives: This study investigated the effects of micronutrient supplementation on psychological well-being of highly active antiretroviral therapy (HAART)-naive HIV-infected patients. Materials and Methods: A total of 90 HAART-naive HIV-infected patients completed the Distress Thermometer and its Problem Checklist, the Hospital Anxiety and Depression Scale, the Oslo Social Support Scale, and the 14-Item Resilience Scale (RS-14) at baseline. They all received a micronutrient supplement for 6 months, and 68 of the participants who remained in treatment at 6 months were reassessed with the same instruments. Results: There was no significant difference between sociodemographic characteristics of participants at baseline and 6 months. After 6 months of micronutrient supplementation, participants were found to have significantly lower mean scores on the anxiety (P = 0.003), depression (P = 0.001), and overall distress (P = 0.001) subscales and significantly higher mean scores on the RS (P = 0.025). Conclusion: Micronutrient supplementation can reduce the experience of distress, anxiety, and depression and increase the resilience in HAART-naive HIV-infected persons.