Sample Of HIV-positive Patients Research Articles

Temperament profiles and posttraumatic stress disorder symptoms: A comparative study between uniformed services, HIV-infected patients and a nonclinical sample

This study aimed to explore heterogeneity in temperament traits, as described by the regulative theory of temperament (RTT), in a sample of HIV-positive patients and uniformed services personnel who have experienced various traumatic events. In addition, we wanted to examine if the profiles of these samples that were extracted based on RTT traits differ in the intensity of their posttraumatic stress disorder (PTSD) symptoms. The total study sample consisted of 1160 participants, including 417 uniformed services personnel, 310 HIV-positive individuals and 432 adults from the general population without declared traumatic experiences. The participants from the clinical samples completed the PTSD-Factorial Version (PTSD-F) questionnaire, and all study groups completed the Formal Characteristics of Behaviour – Temperament Inventory (FCB-TI). Latent profile analysis showed unique temperament profiles in the clinical samples, differing in RTT traits and PTSD intensity compared with the general population. The person-centred approach to personality and temperament provides insights beyond what can be attained using a variable-centred framework. In particular, there is no single pattern of isolated temperament traits as PTSD risk factors.

Prevalence of peri-implantitis in a sample of HIV-positive patients.

ObjectivesThis study aimed to assess the prevalence of peri‐implantitis in human immunodeficiency virus (HIV)‐positive patients and the presence of a possible correlation between the immunological profile and serological values, of peri‐implantitis, and of possible differences between all‐on‐4 and single crown/bridge prostheses.Subjects and methodsThis retrospective study included 58 adult HIV‐positive patients (222 implants) with either all‐in‐4 prostheses or single crowns/bridges on at least one dental implant loaded for more than a year who were followed for 3 year (mean follow‐up). Data pertaining to the probing pocket depth (PPD), bleeding on probing, and immunological and systemic profile were collected.ResultsPatients with single crown/bridge implant rehabilitation showed higher prevalence of peri‐implantitis (34%) than patients with all‐on‐4 rehabilitation (0%) (p = 0.012). Patients with all‐on‐4 rehabilitation were significantly older than those with single crowns/bridges (p = 0.004). Patients with peri‐implantitis had implants for a significantly longer duration than those without (p = 0.001), implying that the probability of peri‐implantitis increases as the age of implant increases.ConclusionsThe prevalence of peri‐implantitis was 26% in the HIV‐positive patients population. No correlation was found between patients' immunological and serological factors and peri‐implantitis. The most important risk factor for peri‐implantitis and mucositis was implant age.

Suicidal Ideation Among Adults Re-engaging in HIV Care in Argentina.

Argentina has one of the highest suicide rates in Latin America and the Caribbean. Though people living with HIV are at increased risk for suicidal behavior, little research on suicide risk has been conducted among HIV-positive people in this region. This study examined risk factors for suicidal ideation among HIV-infected adults (N = 360) re-engaging in care in Argentina. Overall, 21% of participants reported suicidal ideation in the past week. In adjusted logistic regression models, younger age, increased depressive symptomatology, and drug abuse were associated with suicidal ideation (p < 0.05); decreased motivation for adherence and fewer months since initiating antiretroviral therapy approached significance (p = 0.07). Suicidal ideation was common in this sample of HIV-positive patients in Argentina. Findings highlight the need for routine risk assessment and interventions integrated into the HIV care continuum, addressing depression, substance use, and suicidal behavior.

Integrating cardiovascular disease risk factor screening into HIV services in Swaziland: lessons from an implementation science study.

To study the feasibility of cardiovascular disease risk factor (CVDRF) screening at an HIV clinic in Swaziland. A sample of HIV-positive patients at least 40 years on antiretroviral treatment was screened for hypertension, diabetes, hyperlipidemia, and tobacco smoking. A total of 1826 patients were screened; 684 (39%) had at least one CVDRF. Screening volume varied markedly, and was limited by staffing, space, and supplies. CVDRF screening was feasible and prevalence of risk factors in people living with HIV at least 40 years was high.

Prevalence of Occult Hepatitis B in HIV Positive Patients (Adolescents and Adults) in Kermanshah- Iran

Background Occult hepatitis B infection (OBI) is considered a risk factor for progression of liver disease in patients with hepatitis B virus (HBV) infection. This disease progression is reported to be more significant in those with concomitant HIV infection. We aimed to determine the prevalence rate of OBI in a sample of HIV-positive patients. Materials and Methods: Sixty-six HIV-infected patients with positive Hepatitis B core antigen (HBcAb) and negative Hepatitis B surface antigen HBsAg were included. HBV DNA was measured by real time polymerase chain reaction PCR method. Those with positive HBV viral load were considered as seropositive OBI. Then, the patients were studied regarding age, gender, intravenous drug use (IVDU), CD4 count, and concomitant infection by hepatitis C virus (HCV), available in their medical records. Results: Seventy-seven patients (38.5%) had positive HBc antibody (HBcAb). Of 66 patients who were positive for both HIV and HBc antibody, eight patients (12.12%) had OBI. About 3.7% in age group younger than 40 years and 5.3% in age group older than 40 years, OBI was detected. Forty-four patients (54.5%) were male. OBI rate was 22.2% in males and zero in females (P 350/mL, 4.1% had OBI. In those who were IV drug user, 17.94% and in those who were not IV drug user, 3.57% gad OBI. Conclusion The prevalence of OBI in the studied sample of HIV-infected patients is considerable. As we did not find any significant association between OBI and studied factors except for gender, we think that screening for OBI would be useful for HIV-infected patients, especially male patients.

Factors influencing reproductive choices of HIV positive individuals attending primary health care facilities in a South African health district

BackgroundThere is global recognition of the reproductive health rights of people living with HIV (PLHIV). The aim of this research study was to explore the reproductive choices, and the factors influencing these choices, of HIV positive patients attending primary health care (PHC) facilities in the Ekurhuleni health district of the Gauteng Province of South Africa.MethodsDuring 2013, a cross-sectional survey was conducted in the Ekurhuleni health district. At each of three randomly selected community health centres, a random sample of HIV positive patients was selected. After informed consent was obtained, trained fieldworkers administered a structured questionnaire that elicited information on socio-demographics, reproductive choices and knowledge of reproductive options. Survey data were analysed using STATA® 13.ResultsThe majority of survey participants (n = 430) were female (70%) and unemployed (57%). The mean age of participants was 36.4 years (SD 8.6): 40.8 years (SD 8.7) for men and 34.5 years (SD7.8) for women.Among survey participants, 46% expressed a desire for children (95% CI: 41.4–50.9). In the multiple logistic regression analysis, predictors of desire for children were age less than 49 years, marriage or living together, and no biological children. The odds of wanting children was 16.48 [95% CI: 5.94–45.74] times higher for PLHIV without children, compared with those with two or more children, while for those less than 25 years, the odds of wanting children was 0.78 [95% CI: 0.23–2.59] compared with those older than 50 years.The PLHIV knowledge on the available reproductive options was limited, with the majority relying on the guidance of the health workers.ConclusionHealth care providers at PHC level should be educated to address the reproductive health needs of PLHIV. These aspects should be reflected in provincial and national health policies.

Subtypes of depressive symptoms and inflammatory biomarkers: An exploratory study on a sample of HIV-positive patients

Depressive symptoms cause major impairment and may accelerate HIV progression despite the use of antiretroviral medication. The somatic symptoms criteria for HIV infection and depression partially overlap, which can make differential diagnosis challenging. Because of chronic inflammation caused by HIV infection, HIV-positive patients may develop somatic and affective-cognitive symptoms of depression. Inflammation-related depression is primarily characterized with severe somatic symptoms such as fatigue and sleep disturbance. This study sought to explore the patterns of somatic and cognitive-affective depressive symptoms that characterize HIV-positive patients. Our specific aims were (1) to identify subtypes of depressive symptoms in a sample of HIV-positive patients; and (2) to test the subtypes’ difference on inflammatory and HIV disease progression biomarkers. HIV-positive men and women (N=102) with and without depressive symptoms were randomly selected from an Italian HIV clinic. Depressive symptoms (PHQ-9), viral load (VL), CD4+, Il-6, TNF-α, and monocytes were assessed. The three subtypes formed using Latent Class Analysis (LCA) identified patients with (1) severe cognitive-affective and somatic depressive symptoms; (2) severe/moderate somatic symptoms; and (3) absent or low depressive symptoms. The subtype with severe/moderate somatic symptoms was characterized with elevated levels of Il-6 and monocytes. No difference on HIV progression biomarkers was found. The subtypes of depressive symptoms might help differentiating depressive symptoms from HIV- and inflammatory-related somatic symptoms. When present, cognitive-affective and/or somatic symptoms cause significant impairment to patients’ lives and thus warrant further assessment and treatment.

Intervenções cognitivo-comportamentais em pacientes com HIV/aids: revisão da literatura

Este estudo objetivou identificar e analisar publicações científicas sobre intervenções cognitivo-comportamentais em pacientes com HIV/aids. Procedeu-se a um levantamento da literatura nas bases de dados PubMed, SciELO e PePSIC. As combinações de unitermos para a busca dos artigos foram: cognitive-behavioral intervention and AIDS; cognitive-behavioral intervention and HIV; intervenção cognitivo-comportamental and AIDS; intervenção cognitivo-comportamental and HIV. Os critérios de inclusão foram: estudos empíricos de intervenções cognitivo- comportamentais; amostra composta por pacientes HIV positivos; artigos publicados entre 2008 e 2012. Foram selecionados 15 artigos, quatorze deles publicados em língua inglesa. Constatou-se que, em geral, os resultados relatados evidenciaram que as intervenções foram eficazes para propiciar melhora em variáveis emocionais e comportamentais. Conclui-se que a abordagem cognitivo-comportamental constitui-se em estratégia de orientação teórica e metodológica de intervenção que pode contribuir para um enfrentamento adaptativo às múltiplas demandas de ajustamento, decorrentes da convivência com uma doença ainda estigmatizada e crônica como a aids.

Total protein, albumin and low-molecular-weight protein excretion in HIV-positive patients

BackgroundChronic kidney disease is common in HIV positive patients and renal tubular dysfunction has been reported in those receiving combination antiretroviral therapy (cART). Tenofovir (TFV) in particular has been linked to severe renal tubular disease as well as proximal tubular dysfunction. Markedly elevated urinary concentrations of retinal-binding protein (RBP) have been reported in patients with severe renal tubular disease, and low-molecular-weight proteins (LMWP) such as RBP may be useful in clinical practice to assess renal tubular function in patients receiving TFV. We analysed 3 LMWP as well as protein and albumin in the urine of a sample of HIV positive patients.MethodsIn a cross-sectional fashion, total protein, albumin, RBP, cystatin C, and neutrophil gelatinase-associated lipocalin (NGAL) were quantified in random urine samples of 317 HIV positive outpatients and expressed as the ratio-to-creatinine (RBPCR, CCR and NGALCR). Exposure to cART was categorised as none, cART without TFV, and cART containing TFV and a non-nucleoside reverse-transcriptase-inhibitor (TFV/NNRTI) or TFV and a protease-inhibitor (TFV/PI).ResultsProteinuria was present in 10.4 % and microalbuminuria in 16.7 % of patients. Albumin accounted for approximately 10 % of total urinary protein. RBPCR was within the reference range in 95 % of patients while NGALCR was elevated in 67 % of patients. No overall differences in urine protein, albumin, and LMWP levels were observed among patients stratified by cART exposure, although a greater proportion of patients exposed to TFV/PI had RBPCR >38.8 μg/mmol (343 μg/g) (p = 0.003). In multivariate analyses, black ethnicity (OR 0.43, 95 % CI 0.24, 0.77) and eGFR <75 mL/min/1.73 m2 (OR 3.54, 95 % CI 1.61, 7.80) were independently associated with upper quartile (UQ) RBPCR. RBPCR correlated well to CCR (r2 = 0.71), but not to NGALCR, PCR or ACR.ConclusionsIn HIV positive patients, proteinuria was predominantly of tubular origin and microalbuminuria was common. RBPCR in patients without overt renal tubular disease was generally within the reference range, including those receiving TFV. RBP therefore appears a promising biomarker for monitoring renal tubular function in patients receiving TFV and for distinguishing patients with normal tubular function or mild tubular dysfunction from those with severe renal tubular disease or Fanconi syndrome.

Prevalence of Hypovitaminosis D and Factors Associated With Vitamin D Deficiency and Morbidity Among HIV-Infected Patients Enrolled in a Large Italian Cohort

A high prevalence of hypovitaminosis D (hypD) in HIV-infected patients has been reported, but reasons are unclear. The 25 hydroxy vitamin D (vitD) concentration was measured in a sample of HIV-positive patients from Italy enrolled in the Icona Foundation Study. The change in absolute levels of vitD pre/post combination antiretroviral treatment was modelled by linear regression controlling for confounders and seasonality. Factors associated with hypD were identified using logistic regression analysis, and survival analysis was employed to evaluate the prognostic value of vitD concentration to predict severe diseases (diabetes, cardiovascular, renal), AIDS, and death. We studied 810 patients contributing 1408 vitD measures. Median age was 36 years (range: 20-69). VitD insufficiency (30-75 nmol/L) and deficiency (<30 nmol/L) were found in 47% and 6% of the measures. Factors independently associated with vitD deficiency were African or Centre/South American nationality [odds ratio (OR): 4.16 vs. European, P = 0.04], the sample being collected in spring (OR: 11.27, P = 0.001) or in winter (OR: 4.22, P = 0.03) vs. summer, and a previous history of severe diseases (OR: 5.43, P = 0.03) or AIDS (OR: 2.44, P = 0.04). Over a median follow-up of 6.3 years, patients with vitD insufficiency were at higher risk of subsequent severe diseases than those with normal levels (relative hazard = 1.60, P = 0.05). Our analysis shows that despite the relatively young age of our HIV-infected population, the prevalence of hypD was high. Classic risk factors for hypD in the general population were confirmed in this setting. HypD seems to be moderately associated with the risk of severe disease, AIDS, and death.

Structural gray and white matter changes in patients with HIV

In this cross-sectional study we used magnetic resonance imaging (MRI)-based voxel based morphometry (VBM) in a sample of HIV positive patients to detect structural gray and white matter changes. Forty-eight HIV positive subjects with (n = 28) or without (n = 20) cognitive deficits (mean age 48.5 ± 9.6 years) and 48 age- and sex-matched HIV negative controls underwent MRI for VBM analyses. Clinical testing in HIV patients included the HIV dementia scale (HDS), Unified Parkinson's Disease Rating Scale (UPDRS) and the grooved pegboard test. Comparing controls with HIV positive patients with cognitive dysfunction (n = 28) VBM showed gray matter decrease in the anterior cingulate and temporal cortices along with white matter reduction in the midbrain region. These changes were more prominent with increasing cognitive decline, when assigning HIV patients to three cognitive groups (not impaired, mildly impaired, overtly impaired) based on performance in the HIV dementia scale. Regression analysis including all HIV positive patients with available data revealed that prefrontal gray matter atrophy in HIV was associated with longer disease duration (n = 48), while motor dysfunction (n = 48) was associated with basal ganglia gray matter atrophy. Lower CD4 cell count (n = 47) correlated with decrease of occipital gray matter. Our results provide evidence for atrophy of nigro-striatal and fronto-striatal circuits in HIV. This pattern of atrophy is consistent with motor dysfunction and dysexecutive syndrome found in HIV patients with HIV-associated neurocognitive disorder.

The impact of herbal remedies on adverse effects and quality of life in HIV-infected individuals on antiretroviral therapy

Use of herbal remedies among HIV-infected individuals in Africa increased in the past decade, mainly due to traditional beliefs and at times inconsistent access to antiretroviral drugs. In Zimbabwe, accessibility and availability of antiretroviral drugs has increased in recent years; however, the use of herbal remedies remains high. This study was conducted to determine the impact of concomitant use of herbal remedies with antiretroviral drugs on adverse events and on quality of life. A convenient sample of HIV positive patients at Parirenyatwa group of hospitals' Family Care Clinic (Harare, Zimbabwe) was enrolled. A questionnaire was used to collect data on the adverse event experiences of the patients using herbal remedies for their HIV, as well as the types of herbal remedy used. Quality of life index was measured using an HIV/AIDS targeted quality of life (HAT-QOL) tool developed by the World Health Organization. Abdominal pain (odds ratio = 2.7, p-value = 0.01) and rash (odds ratio = 2.5, p-value = 0.02) had significant associations with using herbal remedies during antiretroviral therapy. Improved quality of life index was not significantly associated with herbal remedy use during antiretroviral therapy. There is evidence to suggest that some traditional herbal remedies used in Zimbabwe may increase incidence of certain types of adverse events when used in combination with antiretroviral drugs. Use of herbal drugs in combination with antiretroviral therapy does not significantly improve quality of life index in comparison to antiretroviral drug use only.

Opportunistic Intestinal Protozoan Parasitic Infection in HIV Positive Patient in Jamnagar, Gujarat

The case definition of AIDS encompasses a spectrum of infections and malignancies, labelled as opportunistic infections. In recent years, numerous studies have outlined the emergence of opportunistic gastrointestinal protozoa that have caused diarrhoeal illness among HIV - AIDS patients. Purpose of present study was to determine the prevalence of opportunistic intestinal protozoal parasites in HIV positive patients with or without diarrhoea. A total of 100 stool samples of HIV positive patients were examined for protozoal parasites by microscopy. Protozoal parasites were detected in 25 HIV positive patients; in 41.37 % of patients with diarrhoea and in 2.38% of patients without diarrhoea. Isospora belli appeared to be a predominant parasite associated with diarrhoea among HIV patients. Cryptosporidium revealed of its asymptomatic carriage along with its association with acute and chronic diarrhoea. Prevalence of Microsporidia and Cyclospora cayetenensis was found to be very low. Key words: HIV; diarrhoea; opportunistic protozoa. DOI: 10.3126/saarctb.v5i1.3079 SAARC J. Tuber. Lung Dis. HIV/AIDS 2008 Vol.5(1) 21-24

P01-281 - Psychopathological features in somatic asymptomatic HIV positive patients

BackgroundMany studies on samples of HIV-positive patient's shows correlation of psychiatric symptoms and medical and immunological symptoms of HIV infection. Also, presence of psychiatric distress was showed in some somatic diseases, especially the ones which lead to chronic.AimThe aim was to examine presence of psychopathological symptoms among HIV-1 infected patients which haven’t developed AIDS, in comparison to hepatitis B or C infected patients.MethodsSample for consisted of 60 patients: a) 30 somatic asymptomatic HIV-1 seropositive patients who constituted study group, and b) 30 patients infected with hepatitis B or C which constituted control group. All of them have been assessed on the presence of psychiatric symptoms by the SCL-90 (The Symptom Checklist 90). After the assessment those two groups were compared by student's t test on every subscale and total score.ResultsResults of the study showed that patients in both groups exhibited moderate presence of psychopathological symptoms, especially symptoms of depression, anxiety and interpersonal sensitivity. Moreover, patients with HIV exhibited obsessive-compulsive symptoms. Results showed that there are no statistically significant differences in presence psychopathological symptoms between somatic asymptomatic HIV-positive patients and patients infected with hepatitis B or C.ConclusionBased on the results of this study it could be concluded that, beside the moderate presence of psychopathological symptoms in the samples of somatic asymptomatic HIV-positive patients and hepatitis B or C infected patients, there is no statistically significant difference in those samples of patients.

CD4 Cell Count Distributions and HIV‐Associated Mortality in Africa

Lawn and Wood raise an important issue concerning the relationship between CD4 cell counts and mortality in people infected with HIV and note that there is substantial variation in CD4 cell counts at death. As CD4 cell counts decline the incidence of opportunistic infections increases monotonically; if such infections are left untreated then people may die when their CD4 cell counts are still relatively high just as an HIV-negative person might. For example in a comparison of 8 studies the mean CD4 cell count in HIV-positive patients presenting with tuberculosis was 202 cells/µL (range 136-269 cells/µL). If better data on the time course of CD4 cell counts in a sufficiently large sample of HIV-positive patients were available more-sophisticated models of the relationship between CD4 cell count decline the incidence of opportunistic infections and mortality could be developed. Our model which draws on the limited data that are currently available is a step in this direction. It is nevertheless worth noting that evidence from industrialized as well as low- and middle-income countries suggests that the majority of AIDS-related deaths occur at very low CD4 cell counts. For example in a study in South Africa in the early 1990s the median CD4 cell count at the onset of AIDS was 98 cells/µL for heterosexual patients and 40 cells/µL for homosexual patients after which the median survival time was 17 and 7 months respectively. In an Australian cohort followed between 1986 and 1991 the median CD4 cell count at death was 10 cells/µL. In Uganda a recent study showed that the median CD4 cell count at death was 24 cells/µL. In the United Kingdom a study reported mean CD4 cell counts at death of 19 cells/µL in 1988 44 cells/µL in 1997 and 58 cells/µL in 1998. (excerpt)

Serological and molecular detection of HHV-8 in Brazilian populations

Little is known about human herpesvirus 8 (HHV-8) distribution in Brazil. We used indirect immunofluorescence serological assays to determine HHV-8 seroprevalence in two Amerindian tribes from the Amazon region, and blood donors and Kaposi’s sarcoma (KS) patients from the Campinas/SP (Southeastern region). Anti-HHV-8 antibodies were detected in 56.8% of the Amerindians (558/982), in all ages (0-81 years old) and both sexes. In these populations, high prevalence in children younger than 2 years old (44.4%) and children from 2 to 9 years old (35.0%) suggests non-sexual routes of HHV-8 transmission, through vertical transmission or contact to contaminated secretions. HHV-8 seroprevalence in blood donors from Campinas/SP was low (2.8%) and all positive cases were male (9/319) in the fourth and fifth decades of life. Curiously, these individuals were negative to routine serological tests applied in blood banks. Every KS patient assessed in our study was male, with average age of 37 years (27 to 79 years) and anti-HHV-8 positive assays in all cases. In order to determine HHV-8 molecular prevalence, we analyzed DNA from three Amerindian tribes from the Amazon region, KS patients from Campinas/SP and HIV patients from Salvador/BA (Northeastern region). We used Nested-PCR to amplify HHV-8 ORF-26 region by molecular screening. Every ORF-26 amplified sample was also amplified to hypervariable ORF-K1 region for HHV-8 genotyping. We analyzed 384 DNA samples from Amerindian tribes and detected HHV-8 sequences in 3.8% (13/384). KS patients had all DNA samples from skin biopsies and 45.5% from peripheral blood (PBMC) amplified. DNA samples from 148 HIV positive patients were analyzed and HHV-8 sequences were detected in 4% of cases (6/148). Almost all positive DNA samples were amplified to ORF-K1 and determined HHV-8 subtypes. Molecular techniques for amplification and sequencing of two fragments (VR1 and VR2) from ORF-K1 region made possible to build up phylogenetic trees and determine HHV-8 main viral subtypes (A, B, C, D and E) and its variants. Patients with KS from Campinas had subtypes A, B and C detected, with greater frequency of subtype C. Subtypes A and E were detected in Amazon Amerindians. This study is the first to perform genotyping in samples of HIV positive patients from Salvador, detecting subtype B and an unclassified subtype. Thus, it was possible to determine that HHV-8 subtypes A, B, C and E are present in Brazilian populations. As Brazil is a large country with variable population, culture and different geographical characteristics, more HHV-8 epidemiological studies are necessary to establish possible regional differences. This study was supported by grants from the Conselho Nacional de Pesquisa (CNPq) and Fundacao de Apoio a Pesquisa na Bahia (FAPESB).

An empirical test of the Information, Motivation and Behavioral Skills model of antiretroviral therapy adherence

Nearly perfect adherence to demanding antiretroviral therapy (ART) is now recognized as essential for HIV-positive patients to realize its life sustaining benefits. Despite the dire consequences of non-adherence, a large number of patients do not follow their ART regimen. While many factors influence adherence, the literature is dominated by studies on only one or a small set of them. Multivariate, theory-based models of adherence behavior are of great interest. The current study tested one such model, the Information, Motivation and Behavioral Skills (IMB) model of ART adherence (Fisher et al., under review ). A sample of HIV-positive patients on ART in clinical care in Puerto Rico (N=200) provided data on adherence-related information, motivation and behavioral skills as well as adherence behavior per se. Structural equation model tests used to assess the propositions of the IMB model of ART adherence provided support for the interrelations between the elements proposed by the model and extended previous work. Implications for future research and intervention development are discussed.

The Relationship Between Type of Mental Health Provider and Met and Unmet Mental Health Needs in a Nationally Representative Sample of HIV-Positive Patients

The Relationship Between Type of Mental Health Provider and Met and Unmet Mental Health Needs in a Nationally Representative Sample of HIV-Positive Patients

Valoración clínica de la prueba Amplified Mycobacterium tuberculosis Direct 2 (AMTD-2, GenProbe) en el diagnóstico rápido de la tuberculosis

To evaluate the performance of the Amplified Mycobacterium tuberculosis Direct Test 2- Gen Probe (AMTD- 2) for direct detection of Mycobacterium tuberculosis in smear-negative samples. From January to December 1999, 683 specimens, 333 respiratory and 350 non-respiratory ones collected from 457 patients, were included in the study. All the samples of HIV-positive patients, the respiratory samples from patients suspected of having pulmonary tuberculosis (at least two by patient) and all non-respiratory samples were included. As diagnosis method of reference, the culture isolation was considered. Clinical data were analyzed in case of discrepant results and clinical diagnosis was considered the reference criteria. The technique was performed once a week. The sensitivity, specificity, and positive and negative predictive values of this assay were 58.9%, 93.9%, 37.1% and 97.4% respectively related to the standard culture. When referred to clinical diagnosis of active tuberculosis, these values improved to 70.4%, 97.7%, 73.1% and 96.8% respectively (in respiratory samples were 67.6%, 98.6%, 86.2% and 95.9% and in nonrespiratory ones 76.5%, 96.9%, 56.5% and 98.7% respectively). The mean time of diagnosis by culture and by AMTD-2 were 20.3 days (range 10-63) and 5.7 days (range 2-20) respectively. It is concluded that AMTD-2 is a rapid diagnosis method when clinical data are sugestive with active tuberculosis. However, due to the low positive predictive value, it would be convenient to obtain successive samples to confirm the result in patients without clinical evidence of tuberculosis.

Predictors of postextraction complications in HIV-positive patients

Objective. The purpose of this study was to identify factors associated with an increased risk for post-tooth-extraction complications in a sample of HIV-positive patients. Study design. A cohort of HIV-positive patients who required the extraction of one or more teeth was enrolled. The predictor variables were grouped into the following sets: demographics; medical and social history; preoperative clinical findings; preoperative laboratory measures (hematologic, immunologic, and nutritional); and treatment. The outcome variable was defined as the presence or absence of a complication following tooth extraction. Logistic regression techniques were used to identify variables associated with an increased risk for complications following tooth extraction. Results. During the enrollment period, 76 HIV-positive patients were enrolled into the study cohort. Seventeen patients (22.4%) had postoperative complications. Based on the bivariate statistical analyses, variables associated with the presence of postoperative complications were red blood cell count, CD8 count, total number of positive sites tested using cell-mediated immunity skin tests, and extraction technique ( p ≤ 0.05). Using a stepwise logistic regression technique, the variable identified as being predictive of postoperative complications was the CD8 count ( p = 0.02). The post-tooth-extraction complication rate of the HIV-positive patients in this study sample was greater than the rate reported in most other studies (22% vs. 3%–5%). The complications, however, were minor and easily treated. The variable consistently identified with an increased risk for complications was the CD8 count: the lower the CD8 count, the higher the risk for complications. The CD8 count, however, had poor predictive value. Conclusion. In acute clinical situations—for example, in cases of patients with significant dental pain—the results suggest that delaying treatment to obtain laboratory studies may be of little clinical value. It may be appropriate to proceed with suitable, definitive procedure(s) to alleviate symptoms.